Cauda equina syndrome

The spinal cord ends at the upper portion of the lumbar (lower back) spine. However the individual nerve roots at the end of the spinal cord that provide motor and sensory function to the legs and the bladder continue along in the spinal canal. The cauda equina is the continuation of these nerve roots in the lumbar and sacral region. Then these nerves send and receive messages to and from the lower limbs and pelvic organs.

Cauda equina syndrome (CES) occurs when there is dysfunction of multiple lumbar and sacral nerve roots of the cauda equina.

How does cauda equina start ?

Cauda equina syndrome can present in 2 ways:For example acute onset, where the symptoms and signs occur rapidly, and insidious onset, where the condition begins as lower back pain and slowly progresses to bowel and urinary incontinence. Therefore Cauda equina syndrome is  most commonly resulting from a massive herniated disc in the lumbar region. In fact a single excessive strain or injury may cause a herniated disc. However, many disc herniations do not necessarily have an identified cause

Potential Causes

  • Spinal lesions and tumors
  • Spinal infections or inflammation
  • Lumbar spinal stenosis
  • Violent injuries to the lower back (gunshots, falls, auto accidents)
  • Birth abnormalities
  •  Spinal hemorrhages
  • Postoperative lumbar spine surgery complications
  • Spinal anesthesia

Symptoms and Diagnosis

However it is accompanied by a range of symptoms, the severity of which depend on the degree of compression and the precise nerve roots that are being compressed.
Patients with Cauda equine syndrome  may experience some or all of these “red flag” symptoms.

  • Urinary retention: the most common symptom. The patient’s bladder fills with urine, but the patient does not experience the normal sensation or urge to urinate.
  • Urinary and/or fecal incontinence. The overfull bladder can result in incontinence of urine. Incontinence of stool can occur due to dysfunction of the anal sphincter.
  • Sensory disturbance, which can involve the anus, genitals and buttock region.
  • Weakness or paralysis of usually more than one nerve root. The weakness can affect lower extremities.
  • Pain in the back and/or legs (also known as sciatica).
  • Sexual dysfunction.

If a patient is experiencing any of the “red flag” symptoms above, immediate medical attention is required to evaluate whether these symptoms represent CES.

This can be done through taking patient history, physical exam and  conducting MRI OR CT Scans.


Those experiencing any of the red flag symptoms should be evaluated by a neurosurgeon or orthopedic spine surgeon as soon as possible. Prompt surgery is the best treatment for patients with this syndrome. However this should be followed up by Physiotherapy rehabilitation and exercise programme for a steady recovery.

Prepared by :
PT Danson King’ori

 American Association of Neurological Surgeons

Cauda Equina Syndrome

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