Cauda equina syndrome - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

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 paraesthesia; 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.

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Citations

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.[Abstract][Full Text]
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.[Abstract][Full Text]
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.[Abstract][Full Text]
Epstein NE. Review/perspective: operations for cauda equina syndromes - "The sooner the better". 2022 Mar 25;13:100.[Abstract][Full Text]

Referenced Articles

1. Todd NV, Dickson RA. Standards of care in cauda equina syndrome. Br J Neurosurg. 2016 Oct;30(5):518-22.[Abstract]
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