The cauda equina () is a bundle of

spinal nerves A spinal nerve is a mixed nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body. In the human body there are 31 pairs of spinal nerves, one on each side of the vertebral column. These are grouped into the ...

and spinal nerve rootlets, consisting of the second through fifth lumbar nerve pairs, the first through fifth

sacral nerve A spinal nerve is a mixed nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body. In the human body there are 31 pairs of spinal nerves, one on each side of the vertebral column. These are grouped into t ...

pairs, and the coccygeal nerve, all of which arise from the lumbar enlargement and the

conus medullaris ''Conus'' is a genus of predatory sea snails, or cone snails, marine gastropod mollusks in the family Conidae.Bouchet, P.; Gofas, S. (2015). Conus Linnaeus, 1758. In: MolluscaBase (2015). Accessed through: World Register of Marine Species at ...

of the

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the sp ...

. The cauda equina occupies the lumbar cistern, a subarachnoid space inferior to the conus medullaris. The nerves that compose the cauda equina innervate the pelvic organs and lower limbs to include motor innervation of the hips,

knee In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the ...

ankle The ankle, or the talocrural region, or the jumping bone (informal) is the area where the foot and the leg meet. The ankle includes three joints: the ankle joint proper or talocrural joint, the subtalar joint, and the inferior tibiofibular joi ...

s, feet,

internal anal sphincter The internal anal sphincter, IAS, (or sphincter ani internus) is a ring of smooth muscle that surrounds about 2.5–4.0 cm of the anal canal; its inferior border is in contact with, but quite separate from, the external anal sphincter. It is m ...

and

external anal sphincter The external anal sphincter (or sphincter ani externus ) is a flat plane of skeletal muscle fibers, elliptical in shape and intimately adherent to the skin surrounding the margin of the anus. Anatomy The external anal sphincter measures about 8 ...

. In addition, the cauda equina extends to sensory innervation of the

perineum The perineum in humans is the space between the anus and scrotum in the male, or between the anus and the vulva in the female. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), includi ...

and, partially,

parasympathetic The parasympathetic nervous system (PSNS) is one of the three divisions of the autonomic nervous system, the others being the sympathetic nervous system and the enteric nervous system. The enteric nervous system is sometimes considered part of ...

innervation of the

bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine en ...

Structure

In adulthood, the cauda equina is made of lumbosacral spinal nerve roots.

Development

In humans, the spinal cord stops growing in infancy and the end of the spinal cord is about the level of the third

lumbar vertebra The lumbar vertebrae are, in human anatomy, the five vertebrae between the rib cage and the pelvis. They are the largest segments of the vertebral column and are characterized by the absence of the foramen transversarium within the transverse ...

, or L3, at birth. Because the bones of the

vertebral column The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordate ...

continue to grow, by about 12 months of age, the end of the cord reaches its permanent position at the level of L1 or L2 (closer to the head). However, due to normal anatomical variations, the final cord end position may occur anywhere from T12 twelfth thoracic vertebra (T12) to L3. Individual spinal nerve roots arise from the cord as they get closer to the head, but as the differential growth occurs, the top end of the nerve stays attached to the spinal cord while the lower end of the nerve exits the spinal column at its proper level. This results in a "bundle"-like structure of nerve fibers that extends caudally from the end of the spinal cord, gradually declining in number further down as individual pairs leave the spinal column.

Clinical significance

Needle insertion

The cauda equina exists within the lumbar cistern, a gap between the arachnoid membrane and the pia matter of the spinal cord, called the

subarachnoid space In anatomy, the meninges (, ''singular:'' meninx ( or ), ) are the three membranes that envelop the brain and spinal cord. In mammals, the meninges are the dura mater, the arachnoid mater, and the pia mater. Cerebrospinal fluid is located in ...

Cerebrospinal fluid Cerebrospinal fluid (CSF) is a clear, colorless body fluid found within the tissue that surrounds the brain and spinal cord of all vertebrates. CSF is produced by specialised ependymal cells in the choroid plexus of the ventricles of the ...

also exists within this space. Because the spinal cord terminates at level L1/L2,

lumbar puncture Lumbar puncture (LP), also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid (CSF) for diagnostic testing. The main reason for a lumbar puncture is ...

(or colloquially, "spinal tap") is performed from the lumbar cistern between two vertebrae at level L3/L4, or L4/L5, where there is no risk of accidental injury to the spinal cord, when a sample of CSF is needed for clinical purposes.

Cauda equina syndrome

Cauda equina syndrome Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around ...

, a rare disorder affecting the bundle of nerve roots (cauda equina) at the lower (lumbar) end of the spinal cord, is a surgical emergency. Cauda equina syndrome occurs when the nerve roots in the lumbar spine are compressed, disrupting sensation and movement. Nerve roots that control the function of the bladder and bowel are especially vulnerable to damage. It can lead to permanent paralysis, impaired bladder and/or bowel control, loss of sexual sensation, and other problems if left untreated. Even with immediate treatment, some patients may not recover complete function. Cauda equina syndrome most commonly results from a massive disc herniation in the lumbar region. A disc herniation occurs when one of the soft flexible discs that functions as an elastic shock absorber between the bones of the spinal column displaces from its normal position. The herniation occurs after the disc begins to break down with aging and can be precipitated by stress or a mechanical problem in the spine. The result is that the softer, center portion of the disc pushes out and causes pressure on the nerve roots in the lumbar spine. Other causes include spinal lesions and tumors, spinal infections or inflammation, lumbar spinal stenosis, trauma to the lower back, birth abnormalities, spinal arteriovenous malformations (AVMs), spinal hemorrhages (subarachnoid, subdural, epidural), narrowing of the spinal canal, postoperative lumbar spine surgery complications or spinal anesthesia.

Radiculopathy

The cauda equina is vulnerable to being compressed, causing a

radiculopathy Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly (a neuropathy). Radiculopathy can result in pain ( radicular pain), weakness, altered sen ...

History

The cauda equina was named after its resemblance to a horse's tail ( la, cauda equina) by the French anatomist Andreas Lazarius (

André du Laurens André du Laurens (December 9, 1558 – August 6, 1609), was a French physician. Biography Du Laurens was born in Tarascon and was rector of the medical school at Montpellier. He was physician to King Henry IV. His 1594 book comprising fo ...

) in the 17th century.

References

* Saladin, Kenneth S. Anatomy and Physiology The Unity of Form and Function * Smith's Anesthesia for infants and children. 8th edition, Chapter 1, Page 8.

External links

* * *
Dissection of deep back and spinal cord video: great view of the Cauda Equina
* https://web.archive.org/web/20170617012537/http://www.caudaequinauk.com/welcome.php - Cauda Equina Syndrome UK Charity social network {{Authority control Cauda equina Bones of the vertebral column