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Cauda equina syndrome

Updated: May 25, 2020

Anatomical drawing of an upper body highlighting the site of cauda equina syndrome

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?

Common back pain checker card
Cauda equina syndrome warning signs list

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:



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