Evaluation and Management of Cauda Equina Syndrome

Am J Med. 2021 Dec;134(12):1483-1489. doi: 10.1016/j.amjmed.2021.07.021. Epub 2021 Aug 30.


Cauda equina syndrome is a potentially devastating spinal condition. The diagnosis of cauda equina syndrome lacks sensitivity and specificity, sometimes occurring after irreparable neurological damage has happened. Timely diagnosis and treatment is imperative for optimal outcomes and for avoiding medicolegal ramifications. Cauda equina syndrome results from conditions that compress the nerves in the lumbosacral spinal canal. Although no consensus definition exists, it generally presents with varying degrees of sensory loss, motor weakness, and bowel and bladder dysfunction (the latter of which is required to definitively establish the diagnosis). A thorough history and physical exam is imperative, followed by magnetic resonance or computed tomography imaging myelogram to aid in diagnosis and treatment. Once suspected, emergent spinal surgery referral is indicated, along with urgent decompression. Even with expeditious surgery, improvements remain inconsistent. However, early intervention has been shown to portend greater chance of neurologic recovery. All providers in clinical practice must understand the severity of this condition. Providers can optimize long-term patient outcomes and minimize the risk of litigation by open communication, good clinical practice, thorough documentation, and expeditious care.

Keywords: Cauda equina syndrome; Orthopedic surgery; Spine surgery.

Publication types

  • Review

MeSH terms

  • Cauda Equina Syndrome / diagnosis*
  • Cauda Equina Syndrome / etiology
  • Cauda Equina Syndrome / surgery*
  • Decompression, Surgical*
  • Disease Management
  • Epidural Abscess / complications
  • Epidural Abscess / diagnosis
  • Epidural Abscess / surgery
  • Hematoma, Epidural, Spinal / complications
  • Hematoma, Epidural, Spinal / diagnosis
  • Hematoma, Epidural, Spinal / surgery
  • Humans
  • Intervertebral Disc Displacement / complications
  • Intervertebral Disc Displacement / diagnosis
  • Intervertebral Disc Displacement / surgery
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / surgery
  • Magnetic Resonance Imaging
  • Myelography
  • Neurologic Examination*
  • Spinal Injuries / complications
  • Spinal Injuries / diagnosis
  • Spinal Injuries / surgery
  • Spinal Neoplasms / complications
  • Spinal Neoplasms / diagnosis
  • Spinal Neoplasms / surgery
  • Spinal Stenosis / complications
  • Spinal Stenosis / diagnosis
  • Spinal Stenosis / surgery
  • Spondylolisthesis / complications
  • Spondylolisthesis / diagnosis
  • Spondylolisthesis / surgery
  • Tomography, X-Ray Computed