Summary
Definition
History and exam
Key diagnostic factors
- bladder dysfunction
- lower limb weakness
- saddle paresthesia/anesthesia
- bowel dysfunction
Other diagnostic factors
- low back pain
- sciatica
- sexual dysfunction
Risk factors
- lumbar disk herniation
- spinal trauma
- spinal surgery
- spinal epidural abscess
- anticoagulation therapy
- spinal stenosis
- spinal tumor
- ages under 50 years
Diagnostic tests
1st tests to order
- MRI lumbar spine without IV contrast
- CT lumbar spine without IV contrast
Tests to consider
- CT myelography of the lumbar spine
- urodynamic testing
- digital rectal exam
Treatment algorithm
confirmed CES
Contributors
Authors
Kenneth F. Casey, MD, FACS
Clinical Associate Professor
Neurosurgery
Michigan State University
Clinical Associate Professor
Physical Medicine and Rehabilitation
Wayne State University School of Medicine
Detroit
MI
Disclosures
KFC declares that he has no competing interests.
Peer reviewers
Kevin Barraclough, MA, FRCP, FRCGP, LLB
GP
Painswick Surgery
Painswick
Gloucester
UK
Disclosures
KB is an author of references cited in this topic. KB declares that he has no competing interests.
Louis Chang, MD
Assistant Professor of Neurological Surgery
Weill Cornell Medicine
New York
NY
Disclosures
LC declares that he has no competing interests.
References
Key articles
Todd NV, Dickson RA. Standards of care in cauda equina syndrome. Br J Neurosurg. 2016 Oct;30(5):518-22. Abstract
The Royal College of Emergency Medicine. Cauda equina syndrome position statement. Feb 2020 [internet publication].Full text
Finucane LM, Downie A, Mercer C, et al. International framework for red flags for potential serious spinal pathologies. J Orthop Sports Phys Ther. 2020 Jul;50(7):350-72.Full text Abstract
Expert Panel on Neurological Imaging., Hutchins TA, Peckham M, et al. ACR appropriateness criteria® low back pain: 2021 update. J Am Coll Radiol. 2021 Nov;18(11s):S361-79.Full text Abstract
Germon T, Ahuja S, Casey ATH, et al. British Association of Spine Surgeons standards of care for cauda equina syndrome. Spine J. 2015 Mar 2;15(3 suppl):S2-4. Abstract
Chau AM, Xu LL, Pelzer NR, et al. Timing of surgical intervention in cauda equina syndrome: a systematic critical review. World Neurosurg. 2014 Mar-Apr;81(3-4):640-50.Full text Abstract
Epstein NE. Review/perspective: operations for cauda equina syndromes - "The sooner the better". 2022 Mar 25;13:100.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Spinal epidural abscess
- Osteoporotic spinal compression fracture
- Transverse myelitis
More DifferentialsGuidelines
- Best practice guidelines: spine injury
- ACR appropriateness criteria: low back pain
More GuidelinesPatient information
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Spinal cord compression: what is it?
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