Below the level of the first lumbar vertebra, the spinal cord ends and divides into a bundle of nerve roots known as the cauda equina. These nerves continue downward before exiting the spine at different levels.
The dura surrounds these nerves and forms a protective sac filled with cerebrospinal fluid.
Please review the Lumbosacral spine anatomy section for more information.
Problems and this region can lead to low back pain, leg pain, and neurologic dysfunction.
Major Diagnosis Types
Below are the major types we see in our clinic. Click on available links to learn about our approach to the problems.
Cauda Equina Syndrome
Cauda equina syndrome occurs when the bundle of nerves at the bottom of the spinal canal becomes severely compressed.
This condition is a surgical emergency because prolonged compression may lead to permanent weakness, loss of bowel or bladder control, or sexual dysfunction.
Common causes include large disc herniation, tumor, abscess, hemorrhage, and trauma.
Minor Diagnosis Types
These terms are often encountered, but are either less often treated or described within one of the above diagnoses.
Arachnoiditis
Arachnoiditis is chronic inflammation involving one of the membranes surrounding the spinal nerves.
Scar tissue may develop around the nerves, causing them to adhere together.
Possible causes include:
- Previous spine surgery
- Infection
- Hemorrhage
- Trauma
- Chemical irritation
- Multiple spinal procedures
Symptoms vary widely and may include severe burning pain, numbness, weakness, muscle spasms, or chronic nerve pain.
Lumbar Ependymoma
An ependymoma is a tumor that develops from cells lining the central nervous system.
Within the lumbar spine, these tumors commonly arise near the filum terminale or cauda equina.
Most grow slowly but may eventually compress the surrounding nerves.
Lumbar Meningioma
A meningioma is a tumor arising from the dura surrounding the spinal nerves.
Most spinal meningiomas are benign and grow slowly.
As they enlarge, they may compress the nearby nerves and produce gradually progressive neurologic symptoms.
Lumbar Schwannoma
A schwannoma is a benign tumor arising from the cells that surround a spinal nerve.
These tumors typically grow slowly and may eventually compress nearby nerves.
Symptoms depend on the location of the tumor and may include pain, numbness, weakness, or balance problems.
Tarlov Cyst
A Tarlov cyst is a fluid-filled sac that develops along a spinal nerve root.
Most Tarlov cysts are discovered incidentally and never cause symptoms.
Larger cysts may occasionally produce:
- Sacral pain
- Buttock pain
- Leg pain
- Numbness
- Bowel or bladder symptoms
Only a small percentage of Tarlov cysts require treatment.
Tethered Cord Syndrome
Tethered cord syndrome occurs when the spinal cord or its covering becomes abnormally attached to surrounding tissues, limiting its normal movement.
Although usually diagnosed in childhood, some patients do not develop symptoms until adulthood.
Symptoms may include back pain, leg pain, weakness, changes in stride when walking, bladder dysfunction.