The cauda equina syndrome is an urgent condition requiring urgent medical attention aimed at preventing irreversible nerve damage and developing paralysis.
Therefore, to date, the treatment of horse tail syndrome, caused by a herniated intervertebral disc, is carried out by early surgical decompression (the need for which must be confirmed by the appropriate diagnosis). In such cases, operative treatment within 6-48 hours after the onset of symptoms makes it possible to eliminate pressure on the nerve roots by means of laminectomy or discectomy. In the opinion of spinal surgeons, surgical treatment of horse tail syndrome in the specified time significantly increases the chance to avoid persistent neurological disorders.
In addition, surgical treatment may be required to remove spinal tumors, and when this is not possible, radiotherapy or chemotherapy is used. If the syndrome is caused by an inflammatory process, for example, ankylosing spondylitis, anti-inflammatory drugs, including steroids (intravenous Methylprednisolone), are used.
Chronic horse tail syndrome is much more difficult to treat. To get rid of pain, strong painkillers are needed, and doctors recommend using non-steroidal anti-inflammatory drugs (NSAIDs) for this purpose, for example, Lornoxicam (Xefokam) - 4-8 mg (1-2 tablets) two or three times a day. With very severe pain and trauma, the drug is administered parenterally; the maximum permissible daily dose is 16 mg. Contra-indications of Lornoxicam include allergy to NSAIDs, bronchial asthma, poor blood coagulation, peptic ulcers of the gastrointestinal tract, hepatic and renal insufficiency. And the possible side effects of the drug include allergic reactions, headache, sleep disorders, decreased hearing and visual acuity, increased blood pressure and pulse, shortness of breath, abdominal pain, dry mouth, etc.
The use of anti-convulsants with gamma-aminobutyric acid (neurotransmitter GABA) is shown. These medicines include Gabapentin (Gabagama, Gabantin, Lamitril, Neurontin, etc.), which is recommended to take one capsule (300 mg) twice a day. The drug can cause side effects: headache, tachycardia, increased blood pressure, fatigue, nausea, vomiting, etc. With liver diseases and diabetes it is contraindicated.
When it is impossible to empty the bladder, its catheterization is used, and anticholinergic drugs, such as Oxibutinin (Sibutin), are needed to control the functioning of the bladder in conditions of its neurogenic dysfunction. The drug reduces the number of urges to urinate and is prescribed to adults one tablet (5 mg) up to three times a day. The agent is not used if patients have ulcerative colitis, intestinal obstruction and Crohn's disease. Taking Oxibutinin can cause dryness in the mouth, constipation or diarrhea, as well as headache and nausea.
A positive effect with hypoesthesia accompanying horse tail syndrome, give vitamins of group B.
Physiotherapeutic treatment for acute manifestation of the syndrome is simply impossible, and in chronic cases it can be useful provided that there is no inflammatory component. For example, to increase muscle tone there are sessions of hardware electrical stimulation. Physiotherapy is also used to restore the patient after surgery.