Cauda Equina Syndrome

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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What are the symptoms of cauda equina syndrome?

Symptoms of cauda equina syndrome include low back pain, numbness and/or tingling in the buttocks and lower extremities (sciatica), weakness in the legs, and incontinence of bladder and/or bowels. The numbness of cauda equina syndrome typically is in the distribution of where the body would touch a saddle when sitting upon a horse, and is referred to as "saddle anesthesia."

Partial cauda equina syndrome is the terminology that applies when there is incomplete compression of the nerves of the lower spinal cord. This can elicit various degrees and combinations of the symptoms listed above. With complete cauda equina syndrome, the array of symptoms listed above is commonplace.

How is cauda equina syndrome diagnosed?

Cauda equina syndrome is clinically diagnosed based on the characteristic symptoms described above. Often, the physical examination can reveal hyperactive reflexes of the lower extremities. Because the syndrome is a medical emergency, neurosurgery or spinal surgery consultants should be notified immediately. Cauda equina syndrome can be confirmed with neurologic and radiology testing but such testing should not be delayed.

Specialized neurologic nerve testing of the lower extremities, such as nerve conduction velocity (NCV) and electromyography (EMG) tests can indicate nerve irritation effects in the low back. Radiologic testing such as CT (computerized axial tomography) and MRI (magnetic resonance imaging) scanning can document the compressed spinal cord tissue.

What is the treatment for cauda equina syndrome?

Cauda equina syndrome is a medical emergency. Compression of the spinal nerves of the spinal cord can lead to permanent dysfunction of the lower extremities, bladder, and bowels. Once the precise cause of cauda equina syndrome is determined (see above), generally aggressive operative intervention with surgical decompression is initiated. If infection is present, antibiotics are given, usually intravenously. If a tumor is responsible for compression, after surgical decompression, radiotherapy or chemotherapy may be needed.

The long-term management of cauda equina syndrome depends on whether or not there are persisting symptoms after surgical decompression of the irritated nerve tissue. This can require pain medicine, physical therapy, supportive braces, urinary catheters, and other treatments etc. until optimal nerve and muscle recovery occurs.

Medically Reviewed by a Doctor on 5/29/2015

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