Abstract
Cauda equina syndrome (CES) is characterized by low back pain, sciatica, lower limb motor weakness and sensory deficits, saddle anaesthesia, bowel and bladder dysfunction and occasionally paraplegia. The syndrome is classified according to onset: rapid or slow. Rapid onset CES, because of its characteristic presentation is easily recognized. The slow, chronic progression and varying presenting signs and symptoms of slow onset CES often mimic mechanical low back pain and makes the diagnosis difficult in its early stages. The case of a 23-year-old female with slow onset cauda equina is presented to illustrate this. A discussion of lumbar spine anatomy as it relates to the clinical presentation of cauda equina syndrome and the influence of associated degenerative factors follows. The most common presenting signs and symptoms are reviewed with special emphasis on those which can help diagnose CES in its early stages. Patients prognosis following surgical decompression is highlighted.
Keywords: cauda equina syndrome, cauda equina compression, disc herniation, manipulation, chiropractic
Full text
PDF






Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Adams M. A., Hutton W. C. Gradual disc prolapse. Spine (Phila Pa 1976) 1985 Jul-Aug;10(6):524–531. doi: 10.1097/00007632-198507000-00006. [DOI] [PubMed] [Google Scholar]
- Adams M. A., Hutton W. C. Prolapsed intervertebral disc. A hyperflexion injury 1981 Volvo Award in Basic Science. Spine (Phila Pa 1976) 1982 May-Jun;7(3):184–191. [PubMed] [Google Scholar]
- Aho A. J., Auranen A., Pesonen K. Analysis of cauda equina symptoms in patients with lumbar disc prolapse. Preoperative and follow-up clinical and cystometric studies. Acta Chir Scand. 1969;135(5):413–420. [PubMed] [Google Scholar]
- Choudhury A. R., Taylor J. C. Cauda equina syndrome in lumbar disc disease. Acta Orthop Scand. 1980 Jun;51(3):493–499. doi: 10.3109/17453678008990830. [DOI] [PubMed] [Google Scholar]
- Clark K. Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis. 2. Clinical and surgical significance. J Neurosurg. 1969 Nov;31(5):495–498. doi: 10.3171/jns.1969.31.5.0495. [DOI] [PubMed] [Google Scholar]
- Crawfurd E. J., Baird P. R., Clark A. L. Cauda equina and lumbar nerve root compression in patients with AIDS. J Bone Joint Surg Br. 1987 Jan;69(1):36–37. doi: 10.1302/0301-620X.69B1.3818729. [DOI] [PubMed] [Google Scholar]
- Emmett J. L., Love J. G. Urinary retention in women caused by asymptomatic protruded lumbar disk: report of 5 cases. J Urol. 1968 May;99(5):597–606. doi: 10.1016/S0022-5347(17)62756-3. [DOI] [PubMed] [Google Scholar]
- Farfan H. F., Cossette J. W., Robertson G. H., Wells R. V., Kraus H. The effects of torsion on the lumbar intervertebral joints: the role of torsion in the production of disc degeneration. J Bone Joint Surg Am. 1970 Apr;52(3):468–497. [PubMed] [Google Scholar]
- Floman Y., Wiesel S. W., Rothman R. H. Cauda equina syndrome presenting as a herniated lumbar disk. Clin Orthop Relat Res. 1980 Mar-Apr;(147):234–237. [PubMed] [Google Scholar]
- Gallinaro P., Cartesegna M. Three cases of lumbar disc rupture and one of cauda equina associated with spinal manipulation (chiropraxis) Lancet. 1983 Feb 19;1(8321):411–411. doi: 10.1016/s0140-6736(83)91519-2. [DOI] [PubMed] [Google Scholar]
- Haldeman S., Rubinstein S. M. Cauda equina syndrome in patients undergoing manipulation of the lumbar spine. Spine (Phila Pa 1976) 1992 Dec;17(12):1469–1473. doi: 10.1097/00007632-199212000-00005. [DOI] [PubMed] [Google Scholar]
- Hellström P., Kortelainen P., Kontturi M. Late urodynamic findings after surgery for cauda equina syndrome caused by a prolapsed lumbar intervertebral disk. J Urol. 1986 Feb;135(2):308–312. doi: 10.1016/s0022-5347(17)45621-7. [DOI] [PubMed] [Google Scholar]
- Hooper J. Low back pain and manipulation. Paraparesis after treatment of low back pain by physical methods. Med J Aust. 1973 Mar 17;1(11):549–551. [PubMed] [Google Scholar]
- JENNETT W. B. A study of 25 cases of compression of the cauda equina by prolapsed intervertebral discs. J Neurol Neurosurg Psychiatry. 1956 May;19(2):109–116. doi: 10.1136/jnnp.19.2.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kostuik J. P., Harrington I., Alexander D., Rand W., Evans D. Cauda equina syndrome and lumbar disc herniation. J Bone Joint Surg Am. 1986 Mar;68(3):386–391. [PubMed] [Google Scholar]
- Malmivaara A., Pohjola R. Cauda equina syndrome caused by chiropraxis on a patient previously free of lumbar spine symptoms. Lancet. 1982 Oct 30;2(8305):986–987. doi: 10.1016/s0140-6736(82)90184-2. [DOI] [PubMed] [Google Scholar]
- O'Laoire S. A., Crockard H. A., Thomas D. G. Prognosis for sphincter recovery after operation for cauda equina compression owing to lumbar disc prolapse. Br Med J (Clin Res Ed) 1981 Jun 6;282(6279):1852–1854. doi: 10.1136/bmj.282.6279.1852. [DOI] [PMC free article] [PubMed] [Google Scholar]
- SCOTT P. J. BLADDER PARALYSIS IN CAUDA EQUINA LESIONS FROM DISC PROLAPSE. J Bone Joint Surg Br. 1965 May;47:224–235. [PubMed] [Google Scholar]
- SHEPHARD R. H. Diagnosis and prognosis of cauda equina syndrome produced by protrusion of lumbar disk. Br Med J. 1959 Dec 26;2(5164):1434–1439. doi: 10.1136/bmj.2.5164.1434. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tay E. C., Chacha P. B. Midline prolapse of a lumbar intervertebral disc with compression of the cauda equina. J Bone Joint Surg Br. 1979 Feb;61(1):43–46. doi: 10.1302/0301-620X.61B1.154521. [DOI] [PubMed] [Google Scholar]
- Tullous M. W., Skerhut H. E., Story J. L., Brown W. E., Jr, Eidelberg E., Dadsetan M. R., Jinkins J. R. Cauda equina syndrome of long-standing ankylosing spondylitis. Case report and review of the literature. J Neurosurg. 1990 Sep;73(3):441–447. doi: 10.3171/jns.1990.73.3.0441. [DOI] [PubMed] [Google Scholar]
- Wilson C. B. Significance of the small lumbar spinal canal: cauda equina compression syndromes due to spondylosis. 3: Intermittent claudication. J Neurosurg. 1969 Nov;31(5):499–506. doi: 10.3171/jns.1969.31.5.0499. [DOI] [PubMed] [Google Scholar]