A Quick Review and World Statistics




Note: Some of the information may be repeated in earlier Sections/Chapters. We cannot stress enough that Cauda

Equina is dangerous thus we keep hammering home the need for the medical profession to be alert of the RED


Cauda equina syndrome is a rare condition in which exposed nerve fibres located at the bottom of the spinal cord

become irritated. The irritation is caused by something with which the exposed nerves come into contact. The term

Cauda Equina means “horse's tail”; it is so named because of the resemblance. Generally, the sensitive nerve tissue

that comprises the spinal cord and nerve roots is encased in the centre of the spinal column in an area known as the

spinal canal. In this way, the highly responsive nervous tissue is protected from structures that may put pressure on it

(which will likely cause symptoms such as pain and/or altered functionality). 

What Causes Cauda Equina Syndrome?

Most of the time, Cauda Equina Syndrome is caused by a large, centralized herniated disc between the areas of L4/5

and L5/S1. According to research reviewed by the British Medical Journal, only about 0.12% of all herniated discs in

the U.S. likely cause Cauda Equina.  Other, less common causes include trauma or injury to the spine that leads to

fractures and/or subluxations. Tumours or infections that compress the cauda equina may also cause this

syndrome. Bone spurs in the spinal canal are another possible cause.

Tuberculosis, Potts' paralysis and iatrogenic causes (for example spinal manipulation while you're under anaesthesia or

postoperative complications e.g.: Haematomas, ) are also implicated, as are things may that occupy spinal spaces,

such as cysts.  You may be predisposed to cauda equina syndrome if you have spinal stenosis (either congenital or

acquired). If acquired stenosis underlies your cauda equina syndrome, most likely the stenosis comes from disc

degeneration and degeneration of your facet joints. You may also have a thickened ligament flavum and a narrowing of

your spinal canal.

What Are The Main Cauda Equina Syndrome Symptoms

Cauda equina syndrome is roughly categorized into 2 basic types, according to the defining symptom of urinary

retention. Complete CES is accompanied by urinary retention while incomplete is not. With complete CES, urinary

retention has already been diagnosed. With incomplete CES, you may experience reduced urinary sensation, have a

small stream, or similar symptoms, but you're still able to urinate.  Urinary retention can be serious and that's why it's

very important to get checked if you notice any changes in this functionality.  Other symptoms of CES include sexual

dysfunction, dysfunction of the bowel and/or numbness or other sensory changes around your anus. (Numbness

around the anus is called "saddle anaesthesia.") Of course, back pain is a symptom, as are sensory or motor changes

in your lower limbs (including weakness and/or loss of reflexes and more.) Back pain is a symptom, as are sensory or

motor changes in your lower limbs (including weakness and/or loss of reflexes and more.)

Cauda Equina Syndrome symptoms may present themselves in one of three general patterns, which are labelled as

“types. They are: 

  • Type 1: Symptoms are acute and come on very suddenly and intensely. Symptoms of CES caused by a
  •               herniated disc present in this way. 
  • Type 2: As the final destination after a long journey of chronic back pain, with or without sciatica. 
  • Type 3: Insidiously, where you've slowly been experiencing more and more numbness, as well as urinary 
  •             symptoms. 

Diagnosing Cauda Equina Syndrome

Cauda Equina Syndrome is a result of an interruption or dysfunction of the nerves associated with the lumbar and

sacral vertebrae. However, such disruption is only diagnosed as Cauda Equina when your bladder, bowel and/or sexual

function is impaired. This includes the symptom of saddle numbness or saddle anaesthesia, discussed briefly earlier,

which is loss of feeling around the anus.  CES is diagnosed with MRIMyelogram, specialized nerve testing such as

nerve conduction velocity tests and/or electromyography, CT scans. If your doctor suspects you have Cauda Equina,

you'll be subjected to a physical exam that uses palpation (touch) to determine the degree of feeling and response

around your anus and rectum. 

Treatments for Cauda Equina Syndrome

Most of the time, CES is due to a herniated disc; therefore, the treatment of choice will likely be spinal decompression

surgery, probably a discectomy.  Once your CES diagnosis is confirmed by your doctor, and if your MRI shows that the

cause of the pressure on the CES is reversible, at that point, surgery may make the most sense as an immediate

treatment option.  With that said, sometimes emergency surgery is required to enable you to avoid

permanent dysfunction of your lower extremity (or extremities) as well as your bladder, bowel or sexual functioning. 

The effects of untreated Cauda Equina Syndrome can be devastating; the same is true for cauda equina syndrome that

is treated too late. Do not delay in speaking with your doctor about your treatment options.

 If something other than a herniated disc is creating the pressure on your cauda equina, you'll likely need to work with

a specialist or team of specialists to address that problem, as well.

When in Doubt, Get It Checked Out!

The controversies around diagnosis and treatment of CES can easily complicate decision making. However, this

condition is potentially life-threatening, especially so if you do not heed your symptoms. If you notice symptoms, speak

with your doctor as soon as you can. When it comes to Cauda Equina Syndrome, it's only natural to feel embarrassed

about discussing what you notice, or apprehensive about getting checked. But remember, doing so in a timely way may

save your life or at the very least, your quality of life.

The purpose of the survey and study we undertook was to identify and descriptively compare the RED FLAGS

endorsed in guidelines for the detection of serious pathology in patients presenting with low back pain to primary care.

Does CAUDA EQUINA develop more than once?

 As we mentioned earlier in What is Cauda Equina, Yes it can occur more than once and each time in each case of

cauda equina lesion it becomes worse. As a result of recurrent Adjacent Segment Degeneration (ASD) after multiple

lumbar fusions is reported. ASD might be a consequence of biomechanical overload or simply a normal degenerative

process. The reported clinical relevance of ASD is rather low. We describe an unusual case of Cauda Equina

compression at L1–L2 in a patient who had undergone L2–L4 fusion 8 years previously and 2 decompression-fusion

surgeries 16 years before.




Cauda Equina Syndrome Sufferers Global Support Group