Cauda equina syndrome is an uncommon compression of the nerves at the end of the spinal cord within the spinal canal.

• Cauda equina syndrome can be caused by any condition that results in direct irritation or pinching of the nerves at the end of the spinal cord.
• 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.
• Cauda equina syndrome is diagnosed based on the characteristic symptoms and confirmed by neurologic and radiology testing.
• Cauda equina syndrome is a medical emergency generally requiring a surgical decompression operation.
• The outlook for patients affected by cauda equina syndrome is determined by the extent of damage to involved nerve tissue.

What is cauda equina syndrome?

Cauda equina syndrome is an uncommon compression of the nerves at the end of the spinal cord within the spinal canal. The terminology, "cauda equina," literally means tail of horse and refers to the normal anatomy of the end of the spinal cord in the low back where it divides into many bundles of nerve tracts resembling a horse's tail. Compression of the spinal cord at this level can lead to a number of typical symptoms of the syndrome (low back pain, sciatica, saddle sensory changes, bladder and bowel incontinence, and lower extremity motor and sensory loss).

CES symptoms can take a long time to develop and may vary in severity. This can make diagnosis difficult.

In most cases, the bladder and the legs are the first areas to be affected by CES.

For example, you may have difficulty holding or releasing urine (incontinence).

CES can cause Pain or a loss of feeling in the upper parts of your legs, as well as your buttocks, feet, and heels. The changes are most obvious in the “saddle area,” or the parts of your legs and buttocks that would touch a saddle if you were riding a horse. These symptoms can be severe and, if left untreated, worsen over time.

Other symptoms that may signal CES include:

• intense lower back pain
• weakness, pain, or a Loss of sensation in one or both legs
• bowel incontinence
• loss of reflexes in your lower limbs
• sexual dysfunction

If you experience any of these symptoms, you should see a doctor.

A herniated disk is one of the most common causes of CES. A disk is a cushion between the bones in your vertebrae. It’s made up of a jelly-like interior and a tough exterior.

A herniated disk occurs when the soft interior pushes out through the hard exterior of the disk. As you get older, disk material weakens. If the wear and tear is severe enough, straining to lift something heavy or even just twisting the wrong way can cause a disk to rupture.

When this happens, nerves near the disk can become irritated. If the disk rupture in your lower lumbar is large enough, it may push against the cauda equina.

Other possible causes of CES include:

• lesions or tumors on your lower spine
• spinal infection
• inflammation of your lower spine
• spinal stenosis, a narrowing of the canal that houses your spinal cord
• birth defects
• complications after spinal surgery

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.

People most likely to develop CES include those who have a herniated disk, such as older adults or athletes in high-impact sports.

Other risk factors for a herniated disk include:

• being overweight or obese
• having a job that requires a lot of heavy lifting, twisting, pushing, and bending sideways
• having a genetic predisposition for a herniated disk

If you have had a severe back injury, such as one caused by a car accident or a fall, you’re also at higher risk for CES.