Cauda equina syndrome: a review of the current clinical and medico-legal position

Eur Spine J. 2011 May;20(5):690-7. doi: 10.1007/s00586-010-1668-3. Epub 2010 Dec 31.


Cauda equina syndrome (CES) is a rare condition with a disproportionately high medico-legal profile. It occurs most frequently following a large central lumbar disc herniation, prolapse or sequestration. Review of the literature indicates that around 50-70% of patients have urinary retention (CES-R) on presentation with 30-50% having an incomplete syndrome (CES-I). The latter group, especially if the history is less than a few days, usually requires emergency MRI to confirm the diagnosis followed by prompt decompression by a suitably experienced surgeon. Every effort should be made to avoid CES-I with its more favourable prognosis becoming CES-R while under medical supervision either before or after admission to hospital. The degree of urgency of early surgery in CES-R is still not in clear focus but it cannot be doubted that earliest decompression removes the mechanical and perhaps chemical factors which are the causes of progressive neurological damage. A full explanation and consent procedure prior to surgery is essential in order to reduce the likelihood of misunderstanding and litigation in the event of a persistent neurological deficit.

Publication types

  • Review

MeSH terms

  • Decompression, Surgical / legislation & jurisprudence
  • Decompression, Surgical / methods
  • Decompression, Surgical / standards*
  • Early Diagnosis
  • Emergency Medical Services / legislation & jurisprudence
  • Emergency Medical Services / methods
  • Emergency Medical Services / standards*
  • Humans
  • Intervertebral Disc Displacement / complications
  • Intervertebral Disc Displacement / diagnosis
  • Intervertebral Disc Displacement / surgery*
  • Malpractice / legislation & jurisprudence
  • Malpractice / trends*
  • Neurologic Examination / methods
  • Neurologic Examination / standards
  • Polyradiculopathy / diagnosis
  • Polyradiculopathy / etiology
  • Polyradiculopathy / surgery*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • United Kingdom