From the Guidelines
Cauda equina syndrome is a medical emergency that requires immediate attention, and its symptoms include low back pain, bilateral sciatica, saddle anesthesia, bladder dysfunction, bowel incontinence, and progressive lower extremity weakness or numbness, as reported in the 2021 update of the ACR Appropriateness Criteria for low back pain 1. The symptoms of cauda equina syndrome can vary, but they often include:
- Severe low back pain
- Bilateral sciatica (pain radiating down both legs)
- Saddle anesthesia (numbness in the groin, buttocks, and inner thighs)
- Bladder dysfunction (retention or incontinence)
- Bowel incontinence
- Progressive lower extremity weakness or numbness
- Sexual dysfunction These symptoms typically develop rapidly, though they can sometimes progress gradually, and are caused by compression of the cauda equina nerve roots at the end of the spinal cord, often due to a large herniated disc, tumor, infection, fracture, or severe spinal stenosis, as described in the study by Fairbank et al [cited in 1]. The most common cause of cauda equina syndrome is lumbar disc herniation at the L4-L5 and L5-S1 levels, and other etiologies include neoplasm, infection/inflammation, spinal stenosis, and hemorrhage, as stated in the 2021 update of the ACR Appropriateness Criteria for low back pain 1. It is essential to seek emergency medical care immediately if you experience symptoms of cauda equina syndrome, especially bladder or bowel dysfunction combined with saddle numbness, as surgical decompression within 48 hours offers the best chance for recovery and preventing permanent neurological damage, as recommended by Bell et al [cited in 1].
From the Research
Symptoms of Cauda Equina
- The syndrome is characterized by varying patterns of low back pain, sciatica, lower extremity sensorimotor loss, and bowel and bladder dysfunction 2
- Classically, the full-blown syndrome includes urinary retention, saddle anesthesia of the perineum, bilateral lower extremity pain, numbness, and weakness 2
- Decreased rectal tone may be a relatively late finding 2
- Red flags and findings consistent with CES include bilateral neurogenic sciatica, reduced perineal sensation, altered bladder function leading to painless urinary retention, loss of anal tone, and loss of sexual function 3
- Symptoms may occur either suddenly or gradually, and most patients do not present with all of these symptoms 3
Diagnosis and Treatment
- Early diagnosis is often challenging because the initial signs and symptoms frequently are subtle 2
- Diagnosis typically involves magnetic resonance imaging (MRI) or computed tomography myelography if MRI is not available 3
- Treatment relies upon surgical consultation and operative intervention for decompression 2, 3
- The timing of surgical decompression is crucial, with early intervention associated with improved outcomes 4, 5