Cauda equina syndrome, what we need to know?

Cauda equine syndrome (CES) is a very serious spinal injury caused by compression of lower back and sacral nerve roots (also known as cauda equina). This most commonly occurs due to a herniated intervertebral disc, which can cause the nerve compression (1,2)

What is important to underline is that not every herniated disc end up developing CES. Actually, very few. Recent researches have estimated an incidence of CES in 1 to 2 cases over 100.000 population.

What cause CES?1,2
Often, this condition arises as a result of trauma: wounds from cutting and fire weapons, catheter traumas, lumbar fractures with fragment dispersions. When cauda equina is caused by stenosis instead, the primary causes may be a congenital, degenerative narrowing of the spinal canal or inflammatory nature.

How to recognise early signs of CES? 1,2

CES is defined as a syndrome, which means it presents with different symptoms. It can include any of:

– bilateral sciatica
– numbness to the area of the buttocks (saddle anaesthesia) – bladder, bowel and/or sexual dysfunction.

Today we know that once urinary retention has occurred, the prognosis is worse.
CES requires a clinical and radiological diagnosis, so it is crucial that patients get an MRI scan, which is the only way to confirm the condition.

How to prevent CES to occur? Take care of your back.

To date, the medical standard procedure to treat a late stage of CES is surgical.
However, taking care of your back can play a significant role in preventing all those symptoms to occur and you from undergoing surgery.
A routine of physical exercises is considered the best way to help the whole spine to stay fit and resilient[i], no matter how old you are. If your back is painful, the best choice is to consult a specialist healthcare professional and find out what is causing your discomforts. The RRMG team can also best advise you on physical exercises to follow, tailored on your needs.


[1] Todd, N. V., & Dickson, R. A. (2016). Standards of care in cauda equina syndrome. British journal of neurosurgery30(5), 518-522.

[2] Fraser, S., Roberts, L., & Murphy, E. (2009). Cauda equina syndrome: a literature review of its definition and clinical presentation. Archives of physical medicine and rehabilitation90(11), 1964-1968.

[3] Woodfield, J., Hoeritzauer, I., Jamjoom, A. A., Pronin, S., Srikandarajah, N., Poon, M., … & Statham, P. F. (2018). Understanding cauda equina syndrome: protocol for a UK multicentre prospective observational cohort study. BMJ open8(12), e025230.

[4] Bernstein, I. A., Malik, Q., Carville, S., & Ward, S. (2017). Low back pain and sciatica: summary of NICE guidance. Bmj356, i6748.