Cauda Equina Syndrome – Early Recognition and Management

Cauda equina syndrome is a rare ( 5 per 1000 cases) but imprtant cause of acute lower back pain that results from bilateral compression of the lumbosacral nerve roots leading to lower limb, bowel, bladder and sexual dysfunction. 1 At least two thirds of the western world will experience acute lower back pain at some point in their life time and approximately a third will typically seek medical advice.1,2 Over 90% will be due to simple musculoskeletal causes which typically respond well to non surgical treatment.3,4 Set against this benign backdrop is cauda equina syndrome; rare, debilitating and requiring early surgical decompression. The challenge is to spot red flag signs early and to refer patients urgently (Box 1)