Cauda Equina Syndrome
(CES; Compression of Spinal Nerve Roots; Syndrome, Cauda Equina; Spinal Nerve Roots, Compression)
Cauda equina syndrome (CES) is compression of the nerve roots at the base of the spinal cord. The nerve roots (known as the cauda equina) are responsible for the sensation and function of the bladder, bowel, sexual organs, and legs. CES is a medical emergency. If treatment is not started to relieve pressure on the nerves, function below the waist may be lost.
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A common cause of CES is injury of a spinal disc on the nerve roots. A spinal disc is a semi-soft mass of tissue between the bones of the spine. These bones are known as the vertebrae. The discs act as the spine’s shock absorbers. When a disc spills out into the spinal canal, it can press against the bundle of nerves, causing CES. This syndrome may also be caused by:
- Accident that crushes the spine, such as a car accident or fall
- Penetrating injury, such as a knife or gunshot wound
Arthritis, such as
- Mass lesion, such as a blood clot
- Side effect of certain medications
Factors that may increase your risk of CES include:
- History of back problems, such as spinal stenosis
Degenerative disc disease
Birth defects, such as a narrow spinal canal or
- Hemorrhages affecting the spinal cord
- Arteriovenous malformation
- Spinal surgery or spinal anesthesia
- Lesion or tumor affecting the spinal bones, spinal nerve roots, or cerebrospinal fluid (CSF)
- Infection affecting the spine
- Manipulation of the lower back—rarely
CES may cause:
low back pain
- Numbness or tingling in the crotch area known as saddle anesthesia/paresthesia
- Inability to urinate, or to hold urine or feces
- Inability to walk or dragging of foot
- Weakness, loss of sensation, or pain in one or both legs
Sexual dysfunction—erectile dysfunction in men
You will be asked about your symptoms and medical history. A physical exam will be done. A neurological exam, which includes testing reflexes, vision, mental status, and strength, may also be done. A rectal exam may be done to assess anal sphincter function.
Imaging tests evaluate the spine and nearby structures. These may include:
Your muscle activity may be measured. This can be done with
Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Surgery may include:
Laminectomy—to remove a portion of a vertebra, called the lamina
Discectomy—to remove part of an intervertebral disc that is putting pressure on the spinal cord or nerve root
Radiation therapy—If CES is due to cancer, radiation therapy may be an option.
Your doctor may also treat the underlying cause of CES.
The long-term effects of CES can range from mild to severe. Problems may include:
- Difficulty walking
- Problems with bladder and bowels
- Sexual dysfunction
Your follow-up care may involve working with a:
- Physical therapist
- Occupational therapist
- Neurologist—doctor who specializes in the nervous system
- Incontinence specialist—if you have lost bladder control
Your doctor may prescribe medication for:
- Bladder and bowel difficulties
There are no current guidelines to prevent CES.
Cauda Equina Syndrome Resource Center
United Spinal Association
Canadian/American Spinal Research Organizations
Spinal Cord Injury Canada
Bydon M, Lin JA, De la Garza-Ramos R, et al. Time to surgery and outcomes in cauda equina syndrome: an analysis of 45 cases. World Neurosurg. 2016;87:110-115.
Cauda equina syndrome. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00362. Updated March 2014. Accessed November 10, 2017.
Cauda equina syndrome. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T115961/Cauda-equina-syndrome. Updated August 20, 2014. Accessed November 10, 2017.
EBSCO Medical Review Board Rimas Lukas, MD
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