Cauda Equina Syndrome: Symptoms and Treatment

Cauda equina syndrome is a rare neurological condition that requires immediate medical intervention. Find out more about it in this article.
Cauda Equina Syndrome: Symptoms and Treatment

Last update: 06 June, 2021

Doctors consider cauda equina syndrome a medical emergency. They should perform surgical intervention as soon as possible to avoid sequelae. It’s a very rare syndrome as occurs in 1 in 33,000 to 100,000 people.

According to information published in Formación Médica Continuada en Atención Primaria (FMC), one of its usual causes is herniated discs. To fully explain how it occurs, we must first see what it consists of and how it’s treated.

What is cauda equina syndrome?

a person holding their spine.
Cauda equina syndrome is a condition that involves the nerve roots at the end of the spinal cord.

This is a very rare but serious neurological condition that affects the group of nerve roots at the end of the spinal cord.

It’s so rare, however, that there are general practitioners who don’t see a cauda equina syndrome in their entire careers. Specifically, it occurs when the nerves at the end of the spinal cord become compressed, compromising sphincter control and causing other problems.

It’s considered a medical emergency that should be surgically intervened as soon as possible to avoid irreversible sequelae, such as:

  • Bladder problems
  • Not being able to control urination or defecation
  • Difficulty walking

But what is the cauda equina?

The cauda equina is what we call the nerves at the end of the spinal cord, which runs through the lumbar spine and sacrum, down to the legs. It consists of 10 pairs of nerves:

  • L2 to L5
  • The 5 pairs of sacral nerves
  • The coccygeal nerve

The cauda equina is responsible for muscles, skin sensation in the pelvis and legs, as well as bladder and bowel function. Cauda equina is Latin for horsetail.

Symptoms

Although these symptoms aren’t exclusive to cauda equina syndrome, they’re medical emergencies:

  • Severe low back pain
  • Alterations in sensation in the genital area
  • Bladder, bowel, and sexual dysfunction

Early medical attention and treatment are crucial to achieving a full recovery as soon as possible. Symptoms are also classified according to their mode of onset:

Sudden onset

Symptoms develop rapidly and include:

  • Severe low back pain
  • Significant loss of bladder and bowel function
  • Deficits in motor control and waist down sensation usually occur within 24 hours

Gradual onset

Symptoms develop progressively and may come and go over the course of weeks or months. The most common are:

  • Partial or intermittent loss of bladder and bowel function.
  • Numbness or altered sensation in and around the genital area
  • Recurrent low back pain
  • Muscle weakness

Treatment

Doctors operating on a patient
The suggested treatment for this rare neurological disorder is surgery. It’s intended to improve the prognosis, but should be performed as soon as possible.

Initial treatment is surgical, and doctors should preferably perform it 24 to 48 hours after the onset of symptoms (in the sudden case) to maximize improvement of the sensory and motor deficit.

Prognosis and recovery depend on a variety of factors, such as how quickly the nerve is decompressed and the degree of nerve damage at the time of surgery.

I have low back pain: could I have cauda equina syndrome?

Having low back pain is extremely common and isn’t indicative of cauda equina syndrome in itself. In conclusion, for doctors to suspect CES, there must also be bladder or bowel symptoms present as mentioned in the previous sections.

When in doubt, see your primary care physician.

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  • Ahmed, T., & Caño, J. G. (2012). Síndrome de la cauda equina. FMC Formacion Medica Continuada En Atencion Primaria, 19(9), 544–546. https://doi.org/10.1016/S1134-2072(12)70467-X
  • Fraser, S., Roberts, L., & Murphy, E. (2009, November). Cauda Equina Syndrome: A Literature Review of Its Definition and Clinical Presentation. Archives of Physical Medicine and Rehabilitation. https://doi.org/10.1016/j.apmr.2009.03.021
  • Lavy, C., James, A., Wilson-MacDonald, J., & Fairbank, J. (2009, April 11). Cauda equina syndrome. BMJ (Online). https://doi.org/10.1136/bmj.b936
  • Gardner A, Gardner E, Morley T. Cauda equina syndrome: a review of the current clinical and medico-legal position (2011). European Spine Journal: Official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3082683/  (accessed 14 February 2020)