Cauda Equina Syndrome

Although cauda equina syndrome is rare, patients should be aware of the syndrome. When left untreated, its consequences are disastrous. This syndrome is a true surgical emergency.


Individuals with cauda equina syndrome present with back pain, motor weakness in the lower extremities, sensory deficits, saddle anesthesia (unable to feel anything in the area that would sit on a saddle: the inner thighs, perineum, sacrum), urinary retention, and bowel incontinence. The motor weakness develops progressively and the sensory deficits may be limited to saddle anesthesia.

Because you answered “yes” to the question of having new bowel or bladder symptoms, you have been directed to this message. Many factors may cause these changes, one of which is cauda equina syndrome. Although you may not have cauda equina syndrome, the only manner in which to know for sure is through a thorough history and physical examination by a physician. Because you answered yes to the sited question, it is absolutely necessary that you be seen by a physician immediately. If you are suffering from cauda equina syndrome, the best results have been shown to result from prompt surgical intervention.


Cauda equina syndrome is caused by mechanical compression of the neural elements below the bottom of the spinal cord. The spinal cord ends at the first to second lumbar vertebrae (L1-2) and continues on from that point as a sack of nerve roots with a common covering. This sack is called the “cauda equina,” which is Latin for “horse’s tail.” If dissected out, the sack looks like a stringy horse’s tail attached to the spinal cord.

Cauda equina syndrome is usually due to a massive disc herniation, most commonly seen at the L4-5 disc, and a related compression of the thecal sac (the surrounding cover of the nerve roots and spinal cord). Cauda equina syndrome can also stem from vertebral collapse due to tumor, infection, trauma, or osteoporosis (rarely).


For patients with these symptoms, an MRI or myelogram with or without a CAT scan should be obtained immediately. If a cause for the compression is found and is amenable to treatment by surgery, the patient should be referred immediately for surgical decompression. The surgical decompression should be done on an emergent basis by Florida spine surgeons. As previously stated, the best results for cauda equina syndrome have been found in patients who received prompt surgical intervention.

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