Cauda Equina Syndrome (CES) is a rare but extremely serious condition where there is compression of the nerve roots at the base of the spinal cord within the spinal canal. If suspected, it is considered as a medical emergency and will require immediate investigation (spinal surgeon and MRI scan) to assess the extent and best course of action.
The Cauda Equina is a collection of nerves that form at the base of the spinal cord (while it is still within the spinal canal) at approximately the L1 level (first lumbar vertebrae). The nerves supply the muscles and sensation for the legs as well as control for the bladder and bowel, and sensation in the saddle region.
What causes Cauda equina syndrome?
CES most commonly occurs as a result of a disc bulge or prolapse but may also occur due to a spinal tumour, infection, spinal haematoma, or acute fracture.
It is vital to identify possible CES as early as possible as this provides the best chance to minimise long term, and possibly irreversible, complications.
Risk factors
A spinal infection, inflammation, hemorrhage, or fracture
Degenerative Disc Disease
A history of back problems, such as spinal stenosis
Previous spinal surgery
Congenital (birth defect) narrow spinal canal
What are the symptoms?
There are four classified stages of Cauda Equina Syndrome. They are outlined below with the symptoms and the recommended action you should take in each case.
Stage 1 - CESS (Suspected)
Acute back pain
Bilateral leg pain
Progressive (worsening) changes in leg strength or sensation
Possible subjective change in sphincter or perineal sensation
Recommendation: close monitoring of symptoms - Bolton NHS Trust — symptom checker
Stage 2 - CESI (Incomplete)
Urinary difficulties, loss of urge to urinate, poor stream
Objective changes / loss of sphincter control (bladder / bowel)
Loss or change in sensation in the perineal (saddle) region
Recommendation: Urgent investigation and surgical opinion
Stage 3 - CESR (Retention)
Above signs and symptoms
Bowel incontinence
Bladder retention
Recommendation: urgent investigation and surgical opinion
Stage 4 - CESC (Complete)
Above signs and symptoms
Complete loss of bladder and bowel control
Recommendation: urgent investigation and surgical opinion
If you have any concerns over whether you may have CES you should get in touch with your doctor or physician as a matter of urgency.
How can I manage Cauda Equina Syndrome?
Carefully monitor symptoms. If any symptoms progress then urgent investigation (MRI scan) and surgical opinion are required.
Use the CES Symptom Checker Cards Bolton NHS Trust — Cauda Equina Syndrome (en) Bolton NHS Trust — Cauda Equina Syndrome (28 languages)
If you are having issues with your lower back and want to get in touch about booking a consultation or a bike fit then please email us: info@thebikethebody.com.