Horsetail Syndrome : Little known symptoms of this disorder

Horsetail syndrome

Lower back pain, numbness in the lower extremities… These symptoms may suggest horsetail syndrome, but what is it and how do you recognize it?


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The ponytail is a collection of nerves located in the lower part of the spine. More specifically, it is located below the spinal cord, in the second lumbar vertebra.

These nerve roots are called horsetails because they take on the appearance of a ponytail.

The role of this body part? To control the organs located in the pelvis and legs.

When the nerves that make up this area are compressed, it is called ponytail syndrome. This condition prevents the nerves from working properly, with consequences for the pelvis and lower extremities.

Horsetail syndrome is a medical emergency because it can cause serious sequelae. Therefore, management within 24 hours of the onset of symptoms is essential.

What are the causes of ponytail syndrome?

Horsetail syndrome is usually caused by a herniated disc, which is characterized by the displacement of an intervertebral disc in the spine.

However, it can also be caused by a tumor that compresses the nerves of the lower back, epidural and/or bone compression, spondylodiscitis, which is a general open spine infection caused by a staphylococcus, or a narrow lumbar canal syndrome.

Horsetail syndrome: what are the symptoms of this disease?

Horsetail syndrome manifests itself through different types of symptoms, ranging from simple pain to motor disorders.

Pain and discomfort in the level:

  • lower back pain, such as cruralgia, which is a pain in the crural nerve, or sciatica, which is a pain in the sciatic nerve
  • of the lower limbs;
  • of the pelvis.

Sensory disturbances, namely

  • Numbness or anesthesia of the lower limbs.

Motor disorders, such as:

  • an inability to walk on spikes or heels;
  • an inability to extend the leg;
  • paralysis of the lower extremities.

Urinary and sphincter disorders, namely

  • delayed urination;
  • an urgent need to urinate:
  • anal sphincter atony;
  • a vaginal anesthetic;
  • sexual impotence in men.

How is horsetail syndrome diagnosed?

The diagnosis of ponytail syndrome is based primarily on clinical observation. It is then confirmed with medical imaging tests, such as X-rays or CT scans.

But the first choice exam is the Magnetic Resonance Imaging (MRI), since it allows to explore the whole area of the ponytail.

Horsetail Syndrome: How is it treated?

The only treatment that can overcome horsetail syndrome is surgical. The operation, a lumbar laminectomy, involves decompression of the nerves.

“In the case of a malignant tumor of bone origin: radiotherapy finds its place, either as an emergency combined with corticotherapy in an inoperable patient, or after surgery,” says the Neurosurgery Campus site.

Even when tail syndrome is handled in a timely manner, it is not always without consequences.

“In acute syndromes, despite an intervention within 6 hours, 30% of patients will retain disabling sequelae,” says the Neurosurgery Campus. These sequels can be sphincter, sexual or even manifest themselves as a motor deficit.

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