Cauda Equina Syndrome (CES)

Question 1

How does Cauda Equina Syndrome (CES) occur?

Answer 1

As a result of direct compression on the lumbosacral nerve roots distal to the conus medialis

Question 2

What causes cauda equina syndrome (CES)?

Answer 2

• Large central disc prolapse at L4/5 or L5/S1
• Trauma
• Tumour
• Spinal canal stenosis
• Epidural haematoma
• Epidural abscess/post-op complications

Question 3

What are the ‘red flag’ symptoms of Cauda Equina Syndrome (CES)?

Answer 3

• Saddle anaesthesia
• Abnormal/ataxic gait
• Changes / problems with bladder and/or bowel function
• Changes in sexual function
• Bilateral severe sciatica
• Severe low back pain (LBP)
• History of trauma
• History of cancer
• Severe, unremitting night pain
• Systemic upset or signs of infections
• Unexplained weight loss

Question 4

What must be done is someone presents with Cauda Equina Syndrome (CES)?

Answer 4

• Urgent referral for MRI
• Potential surgery

Question 5

Why is cauda equina syndrome (CES) a medical emergency?

Answer 5

• Impairments can be permanent
• Life altering

Question 6

What are the ‘red flag’ symptoms of Cauda Equina Syndrome (CES)?

Answer 6

• Severe low back pain (LBP)
• Sciatica: often bilateral but sometimes absent, (especially at L5/S1)
• Saddle and/or genital sensory disturbance
• Bladder, bowel and sexual dysfunction
• Disturbed/ataxic gait
• Objective findings (including sphincter tone on digital rectal examination)

Question 7

What questions do you need to ask your patient in relation to Cauda Equina Syndrome (CES)?

Answer 7

• Do you have pain down both legs (sciatica)?
• Have you noticed any changes in your bowel, bladder or sexual function?
• Do you have difficulty controlling your bowel or bladder?
• Can you feel your saddle area when you wipe?
• Have you noticed any disturbances in your walking?

Question 8

What must be done is the patient is suspected to have Cauda Equina Syndrome?

Answer 8

Refer to A&E (or for urgent medical assessment)

Question 9

What are red flag questions for a patient who you suspect has Cauda Equina Syndrome (CES)?

Answer 9

• Do you have severe pain down both legs?
• Have you noticed any changes in your bowel, bladder or sexual function?
• Do you have difficulty controlling your bowel or bladder?
• Can you feel your saddle area when you wipe?
• Have you noticed any disturbances in your walking?