Cauda Equina Syndrome

A serious neurological condition due to compression of the cauda equina nerve roots (located at the lower end of the spinal cord).

• Lumbar disc herniation (most common)
• Spinal tumours
• Spinal stenosis
• Trauma, e.g., fractures
• Infectious conditions, e.g., abscesses
• Spinal haemorrhage or haematoma
• Iatrogenic causes, e.g., post-operative complications

• Severe lower back pain.
• Bilateral sciatica.
• Lower limb weakness and/or numbness.
• Saddle anaesthesia: Numbness around the buttocks, perineum, and inner surfaces of the thighs.
• Bladder and bowel dysfunction (retention, incontinence).
• Sexual dysfunction.
• Loss of reflexes in the lower extremities.

• Urgent MRI spine: Gold standard to identify the cause of compression.
• Clinical examination: Assess tone, power, reflexes, and sensation in lower limbs. Assess perianal sensation and tone.
• Urinalysis: To rule out urinary retention and infection.

• Immediate surgical decompression: To prevent permanent neurological damage. Ideally within 48 hours of symptom onset.
• High dose corticosteroids: Controversial, but sometimes given pre-operatively.
• Bladder catheterisation: If there’s urinary retention.
• Physiotherapy and rehabilitation post-operatively.

Varies depending on the duration of compression before treatment and severity of symptoms. Earlier treatment typically results in a better prognosis.

• Persistent bladder, bowel, and sexual dysfunction.
• Chronic pain.
• Permanent motor and sensory deficits.