Cauda equina syndrome (CES) is compression of the nerve roots at the base of the spinal cord. The nerve roots (known as the cauda equine) control the sensation and function of the bladder, bowel, sexual organs, and legs. It is rare.

Care is needed right away to avoid long-term damage.

Cauda Equina

Causes

The most common cause is a herniated disc. Discs are semi-soft tissue between the bones (vertebrae) of the spine. The discs act as the spine’s shock absorbers. A disc that pushes into the spinal canal can press against the bundle of nerves and cause CES.

Other causes may be:

Tumors
Cancer that spreads from another part of the body
Infection, such as meningitis
Lumbar spinal stenosis —a narrowing of the spinal canal
Blood clots or a buildup of blood that pushes on the spinal canal
Inflammatory health problems, such as ankylosing spondylitis
Trauma, such as from a car accident, gunshot, or knife wound
Complications from surgery, spinal anesthesia, or spinal manipulation methods (less common)

Risk Factors

Things that may raise the risk of this problem are:

A herniated disc or past surgery to treat one
Lumbar spinal stenosis

Symptoms

CES may cause:

Severe low back pain
Problems passing or controlling urine or stool
Numbness or tingling in the crotch
Weakness in the legs
Problems walking, such as dragging a foot
Sexual problems, not being able to maintain an erection (in men)

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. The doctor will look for signs of nerve problems. A rectal exam may be done to check anal function.

Images may be taken of the spine and nearby structures. This can be done with:

Treatment

Underlying causes will need to be treated. Emergency care may also be needed. Choices are:

Surgery

Surgery may be done to ease compression on the nerves. Choices are:

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

Medicine

Symptoms may be managed with medicines, such as:

Pain relievers
Vasodilators to widen blood vessels
Steroids to ease swelling

Rehabilitation

Therapy may be needed to regain lost skills. Options are:

Physical therapy—to improve movement
Occupational therapy—to help with daily tasks and self care
Incontinence care—to manage lost bladder control

Prevention

There are no known guidelines to prevent this health problem.

RESOURCES:

Cauda Equina Syndrome Resource Center
http://www.caudaequina.org

United Spinal Association
http://www.spinalcord.org

CANADIAN RESOURCES:

Canadian/American Spinal Research Organizations
http://www.csro.com

Spinal Cord Injury Canada
http://sci-can.ca

References:

Bydon M, Lin JA, 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:
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Accessed January 14, 2021.

Cauda equina syndrome. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/cauda-equina-syndrome. Accessed January 14, 2021.

Last reviewed December 2020 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 1/14/2021

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