Cauda equina syndrome

Cauda equina syndrome is a serious neurologic condition in which there is compression of the vertebral column (spine) affecting the S1-S4 nerve roots. Most commonly, it is caused by a massive herniated disc at the L4–5 level. Other causes can be traumatic or a tumour. Cauda equina syndrome is a medical emergency, although there is no good evidence that earliest possible operation leads to a better result than after a delay.

Signs

Signs include weakness of the muscles innvervated by the compressed roots (often paraplegia), sphincter weaknesses causing urinary retention and post-void residual incontinence as assessed by catheterizing after the patient has voided. Also, there may be decreased rectal tone; sexual dysfunction; saddle anesthesia; bilateral leg pain and weakness; and bilateral absence of ankle reflexes.

The prognosis for complete recovery is often poor, in spite of emergency operation.