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Finally told I have Cauda Equina Symptoms - MRI help!!!

waynuswwaynus Posts: 46

As some of you may know I have posted up on the boards a few times re L5-S1 disc herniation and groin/perineal numbness and down the left leg etc.

Im having a nightmare still, riddled with pain particulary in the lower back and legs. My so called spcialist has asked my employer to provide the intensive rehab that I require and state i had pre and post op Cauda Equina Symptoms.

I have stood my ground and have been referred to a leading UK Ortho hospital for a second opinion.

Could someone give kindly me some help on the interpretation MRI results i got today. There are 2 below.

Latest MRI

FORMAT: examination performed as per standard protocol supplemented by post-contrast T1 sagittal and axial sequences.
Comparison is made with the pre-operative MRI study from 15/4/2009. A left L5 laminotomy is noted. The previously noted larged extruded L5/S1 disc fragment that was in the sacral canal is no longer present. There is, however, enhancing tissue surrounding the left L1 nerve root within its lateral recess, extending posteriorly to the anterior surface of the remaining cauda equina roots. The appearances are consistent with post-operative epidural fibrosis. Although there is a small residual central focal disc protrusion this does not appear to be compressing. No residual sequestered fragments are demonstrated elsewhere. A small collection measuring 19mm x 8mm axially by 4cm longitudinally is present within the base of the subcutaneous tissues overlying the surgical incision. No other significant interval changes are demonstrated.

Epidural fibrosis within the surgical bed, surrounding the left S1 nerve root and encroaching upon the anterior surface of the remaining cauda equina roots. No significant residual discal components are identified.

April 09 MRI

FORMAT: sagittal T1 and T2 weighted sequences obtained through the whole spine. Axial T2 weighted sequences obtained through the cervical spine and T1 and T2 weighted sequences obtained through the lower lumbar spine.
Note is made of marked loss of the normal cervical lordosis which may indicate muscle spasm. There is already spondylotic change noted but the canal is capacious and no evidence of any cord or thecal sac compression and no obvious nerve root compression. The cord is entirely normal in its appearance.
At the L5/S1 level note is made of an extruded disc fragment which fills the canal compressing the left S2 nerve root prior to its entering into its lateral recess (image 16 of 19). The right S2 nerve root is uninvolved. There is also some thecal sac compression at this level. The S1 nerve roots are normally positioned within their lateral recesses. No other thecal sac or nerve root compression present. There is mild L3/4 and 4/5 disc dehydration noted with high signal present posteriorly within the L3/4 disc. No other abnormalities of note. No para-vertebral abnormalities present.

1. Large extruded disc fragment compressing the left S2 nerve root and the thecal sac at this level.
2. There is evidence of an L3/4 annular tear.
*** Final Report ***

Any advice and help would be great.

Kind regards.


  • What did you doctor say to you about the "pre and post op Cauda Equina symptoms?"

    It appears that the disc fragment referred to in the April scan was successfully removed. The noted change from one MRI to the new one is the presence of epidural fibrosis (scar tissue) that is surrounding the S1 nerve on the left side, and has grown in such a way that it is encroaching on the forward side of the other nerve roots that bundle together at this point (the cauda equina).

    Read about epidural fibrosis here:


  • Hi gwennie17

    Thanks for the reply.

    Re being told of the C Equina symptoms, no one had told me that i had these CES symptoms it was when i saw a rehab physio specialist who wrote in a letter to my employer asking them to provide healthcare and that i had a squashed spinal cord!!! This was the only time someone has mentioned it which alarmed me. Plus I was told there was nothing else they can do and to grin and bare the pain and if necessary and wear a nappy pad if you become incontinent. Plus if i develop bladder problems to be referred to my local dr for a urology referral, absolutley poor service. I was then discharged from outpatients even though they know im in pain still and have complete left perinial numbness which runs down the back of my leg and the genitals. I asked the DR who performed the surgery who made an off the cuff remark that im luck to walk. They couldn't say whether the fact that I was left for over a week since the caudial epidural was conducted and thats when they believe the disc totally hernatied would cause long term nerve damage. No one had mentioned i have any scar tissue developing around the tail of nerves.

    Even when i sneeze by back wants to snap and there is just pain. I walk for about 10 mins and the back is in spasms and the sciatic nerve feels pronouced and gets more numb and pain in the inner thighs. I bend over which seems to release the pressure.

    My local GP feels there could be some stenosis creeping in and has written a strong letter to another hospital asking for a second opinion and to see if anything else can be done.

    speak soon.

  • Any time any of us has surgery or even a cut, scar tissue naturally develops. It is the body's way of healing and filling in a void. Scar tissue is just natural collagen that sometimes forms in a crazy way. Instead of the fibers laying down in an orderly fashion, they grow in every-which-way. Sometimes the little fibers can actually grow around a nerve, which can result in the same type of nerve pain one might feel from a herniated disc or something else.

    The symptoms you describe in the second to last paragraph describe pretty standard symptoms of stenosis. Stenosis just means a narrowing. Anytime something encrouches into the central canal or the neuroforaminal openings, there is a narrowing of the space. Scar tissue can do this, just as a ruptured disc, arthritis, bony overgrowths, etc.can cause this.

    When you lean forward, like when pushing a grocery cart, it opens up the space just enough to give the spinal nerve a little bit more space, which provides some relief from the pain.

    Obviously I have no medical training, but I refuse to believe that there is nothing that can be done for you. If nothing else a surgeon could go in at the lower lumbar area, clean up the area if need be and make a little more space for the nerve root. Or perhaps a fusion could be performed. This would open up the space permanently to allow room for the spinal nerve, and would relieve the sciatic-type nerve pain you are feeling, hopefully.

    Dealing with scar tissue is a more complicated situation. There isn't even agreement on whether it causes pain, or not. But there are several procedures that can treat it, if you can find a doctor who thinks it will help. One procedure is called a lysis of adhesions. Sometimes a good massage therapist or body work therapist can also help to release some of the tangled tissue.

    Do you have access to any spinal specialists where you are located? I don't see why your surgeon would have told you what he did unless you have much more wrong than is indicated on the MRI findings.


  • Hi All,

    As some of you may be aware of my ongoing posts I thought I would post an update of where i am at the moment, apart from being riddled with pain.

    The pain has now increased to the point i cannot lie on my back or front as when i try to stand the back just doesn't stabilise but goes straight into spasms. My walking is still poor and again spasms start soon as i walk with muscle twiches. Plus dull shooting pain down the back of the leg an pain in the big toe.

    I soiled myself and didnt realise that i had done so as my saddle, left buttock and rear of the leg is still numb. I got worried and went to the Emergency room who i have to say for England where pretty good. I was sent the following day to a the top neuro hospital in london and had an emergency mri in the early hours. I have still 2 disc bulges at L5-S1 and the disc above but no significant stenosis, but no compression of the cauda equina. I am going to be seen in Dec as a follow up as i am becoming less mobile and living with chronic pain to the point i cant work. I have now been off work nearly a year.

    The doctors have put me on 60mg a day of MST and Tramadol as a break through with diclofenic and more valium. They think the damage has been done by the large disc hernation that squashed the spinal cord and compressed the S2 nerve which may explain the problems!!!!

    I am going to see a neurosurgeon to see what they can do as living on pain killers and increasing them doesn't solve the problem and to find out whether the numbness could be permanent or any sensation has the potential to return with nerve regrowth.

    Can i ask you guys a few questions to find out your experiences and opinions?

    1. Has anyone had an upright mri which has found something different on their report to the conventional lying down scanner?

    2. If anyone with CES had an overactive bladder, I feel im going to often than usual?

    3. what sort of examination and tests could I expect to help diagnose CES and nerve damage?

    4. General advice would be great!!!

    Man thanks.

  • waynus said:
    Hi All,

    Can i ask you guys a few questions to find out your experiences and opinions?

    1. Has anyone had an upright mri which has found something different on their report to the conventional lying down scanner?

    4. General advice would be great!!!

    Man thanks.

    Howdy Waynus,

    When my C6/7 popped, a "recumbant" (lay down MRI) only showed a minor bulge. A week later since there were a lot of symptoms, I was sent in for a "Stand Up" MRI. When the results and films came back, they revealed my C6/7 herniated "abutting the cord" as well as other issues. These were not seen on the lay down views! After that experience, I will *only* get MRI's of my spine in a positional (stand up) MRI anymore! This allows the doctor to "see" your spine under load. Hope that helps. Good luck with your diagnosis man!!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • I'm really sorry to hear you haven't been able to find the cause of the cauda equina symptoms. Following is a link that should answer some of your questions:


    I recently had a positional MRI, which, incidentally, was excruciatingly painful...if one has pain when standing to begin with, try standing completely still without moving a muscle for 15 minutes at a time! The technician told me three people that week had fainted during the scan. Anyway, in my case, it did not reveal anything new or different, but it did confirm what we suspected...and I was happy to have the results.

    The only test that indicates nerve damage is the nerve conduction study and electromyogram (EMG). And even then, it is a snapshot in time. But you can tell from it if a particular nerve is damaged.

    Hope you can get some treatment soon.

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