List four effects of compression on the cauda equina.

Which lumbar root supplies the urinary bladder sphincter? Describe two of the extremes in clinical presentation when this root is compressed.

List four clinical differences between compression of the spinal cord and of the cauda equina.

List four other possible causes of urinary bladder dysfunction and how would they differ from that caused by cauda equina compromise.

What is the treatment for cauda equina compression?

Bilateral sciatica, deep tendon a/hyporeflexia throughout the legs, bladder/bowel/genital dysfunction, multisegmental fatigable weakness, multisegmental hypoaesthesia, SLR frequently negative, absent or weak anal reflex.

S4. Retention is characterized by frequent strong urges to urinate but very low volume; incontinence by absence of control.

Cauda equina: absent or reduced deep tendon reflexes, hypotonicity, incontinence, normal extensor/plantar response, negative Oppenheimer's, marked atrophy and coarse fasciculations with time
Spinal cord: deep tendon hyperreflexia, hypertonicity, spastic bladder, Babinski response to extensor/plantar test, positive Oppenheimer's, minimal atrophy and fine fasciculations.

Bladder infections, incompetent bladder, spinal cord compression, prostatitis. None would cause bilateral sciatica. In addition, there may be other evidence, general debility with the infection, incontinence with laughing, sneezing, running with stress incontinence, age and gender with the prostatitis.

When undiagnosed, the patient must be referred to the physician. There is a very good chance that this episode of disc herniation or the next might rupture the posterior longitudinal ligament and cause severe compression of the tissue resulting in permanent bowel, bladder and genital function loss. This is especially true when incontinence is present; usually the treatment of choice in these cases is surgical decompression. Some studies have demonstrated that there is a fifty- percent chance of it not occurring. However, with each subsequent episode, the risk goes up. In cases of mild compression, demonstrated by urinary retention rather than incontinence the surgeon and the patient may want to try PT initially. Be careful, you could be held responsible for its natural progression. Get everything in writing and have the physician as well as yourself explain the risks to the patient from PT. Then do no manual therapy, try traction or exercises, but these patients are very acute and the disc bulge large so don't expect too much.