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Cauda Equina Syndrome

Checked: 23-02-2024 by Rob Adams Next Review: 22-08-2024

Overview

Cauda equina syndrome (CES) is a serious spinal condition that requires immediate assessment, investigation, and treatment. If it is unrecognised or treatment is delayed, this may result in permanent loss of bladder and bowel function, loss of sexual function, and lower limb paralysis. Patients may continue to experience ongoing severe disability despite prompt treatment but, if it is treated before symptoms become severe, this can reduce the risk of permanent disability.

CES is due to acute or rapidly progressive compression of the nerves in the lumbar or sacral spinal canal. The most common cause is a large lumbar disc prolapse but can be due to rarer causes such as trauma, infection, tumour, or spinal/epidural anaesthetic

Patients with CES can present to clinicians throughout primary and secondary care and it is essential that there is rapid access to imaging to confirm the diagnosis. The gold standard investigation is MRI scanning.

Please see also the following pages:

Assessment in Primary Care

NHSE have published a GIRFT (Getting It Right First TIme) interactive pathway illustrating best practice for clinicians caring for patients suspected of having Cauda Equina Syndrome (CES).

The link below is directed at clinicians working in primary and community care:

CES Presentation in Primary & Community Care 3a-1 – GIRFT(2)

Referral

Send patients to A&E with suspected cauda equina syndrome. A patient presenting with back pain and/or sciatic pain with:

Saddle anaesthesia, perineal sensory alteration
New difficulty or inability to initiate micturition/painless urinary retention/new onset overflow incontinence
Change in sexual function
Altered bowel or bladder sensation
Inability to move bowels
Lax anal sphincter
Bilateral or progressive neurological deficit in the lower limbs
Bilateral sciatica

****Update February 2024 - There are currently ongoing discussions on pathways of care for patients with suspected CES. Any future updates will be published here.****

Resources

(1) Red flag symptoms and signs | Diagnosis | Sciatica (lumbar radiculopathy) | CKS | NICE

(2) Interactive pathway to help diagnose and treat Cauda Equina Syndrome without delay is now live - Getting It Right First Time - GIRFT

(3) National-Suspected-Cauda-Equina-Pathway-UPDATED-V2-October-2023.pdf (gettingitrightfirsttime.co.uk)

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