Cauda equina syndrome

Cauda equina syndrome (CES) is caused by compression of the lumbosacral nerve roots of the cauda equina.

CES is a neurosurgical emergency, and delays in diagnosis and treatment may lead to permanent disability.

Features of CES include: low back pain; bilateral or unilateral sciatica; progressive neurologic deficits; difficulty starting or stopping urination or impaired sensation of urinary flow; urgency; urinary retention with overflow urinary incontinence; loss of sensation of rectal fullness; fecal incontinence; laxity of the anal sphincter; saddle anesthesia or paresthesia; and sexual dysfunction.

Not all patients show all of the above features, but bladder dysfunction is an essential component of CES.

Magnetic resonance imaging is carried out as soon as possible in patients with suspected CES.

Patients with CES require urgent surgical decompression of the spinal canal.

CES is caused by compression of the lumbosacral nerve roots that extend below the spinal cord. The most common cause is due to disk prolapse at the L4/5 or L5/S1 level and stenosis of the spinal canal. Less commonly, compression may be due to pathology in a higher disk, or to a tumor, infection, or trauma. Typical symptoms and signs of CES include bladder dysfunction, low back pain, bilateral or unilateral sciatica, lower limb weakness or numbness, bowel dysfunction, and sexual dysfunction. Although not all patients show all symptoms and signs, bladder dysfunction is always apparent at some stage in the progression of CES.