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Cauda equina syndrome

Last reviewed: 9 Apr 2025
Last updated: 06 Feb 2023

Summary

Definition

History and exam

Key diagnostic factors

  • bladder dysfunction
  • lower limb weakness
  • saddle paresthesia/anesthesia
  • bowel dysfunction
Full details

Other diagnostic factors

  • low back pain
  • sciatica
  • sexual dysfunction
Full details

Risk factors

  • lumbar disk herniation
  • spinal trauma
  • spinal surgery
  • spinal epidural abscess
  • anticoagulation therapy
  • spinal stenosis
  • spinal tumor
  • ages under 50 years
Full details

Diagnostic tests

1st tests to order

  • MRI lumbar spine without IV contrast
  • CT lumbar spine without IV contrast
Full details

Tests to consider

  • CT myelography of the lumbar spine
  • urodynamic testing
  • digital rectal exam
Full details

Treatment algorithm

ACUTE

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.
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