CAUDA EQUinA – BACkgROUnD
Cauda Equina Syndrome –
A review of the current clinical and
medico-legal position
By Alan Gardner M.B.B.S.(Lond.),F.R.C.S.(Eng.),
Edward Gardner B.M., M.R.C.S.(Ed.) and Tim Morley M.A., M.B., F.R.C.S.(Eng.)

Background 3. Chronic backache and sciatica
DEFINITION CES is a rare condition with a with gradually progressing
Cauda Equina Syndrome disproportionately high medico- CES.
(CES) is a syndrome usually legal profile. It occurs most
characterised by these so- frequently following a large lower Within these groups CES may be
called ‘red flag’ symptoms: lumbar disc herniation, prolapse or complete or incomplete, and its
sequestration. CES may also be onset may be either acute within
• Severe low back pain (LBP) caused by smaller prolapses in the hours or gradual over weeks or
• Sciatica - often bilateral presence of spinal stenosis.
1
months.
21
but sometimes absent -
especially at L5/S1 with an Less common causes are epidural Although the above description
inferior sequestration haematoma,
2
infections,
3
primary is clinically useful, in medico-legal
• Saddle and/or genital and metastatic neoplasms,
4
terms the important distinction is
sensory deficit trauma,
5,7,29
post surgical,
8
whether, at any given time, CES is
• Bladder, bowel and prolapse after manipulation,
15
complete or incomplete in relation
sexual dysfunction after chemonucleolysis,
9
after to bladder function and perineal
spinal anaesthesia
6
- and it has sensation. These are both relatively
been reported in patients with easy to assess and urinary
Sources of funding: None ankylosing spondylitis,
27
gunshot dysfunction is often the most
wounds
49
and even resulting from distressing sequel of CES.
Conflicts of interest: None constipation.
50

When the syndrome is incomplete
Acknowledgements: This review will address the (CES-Incomplete), the patient has
Reprinted by kind permission from The problem of CES, concentrating urinary difficulties of neurogenic
Medical Protection Society on the most common aetiology origin including altered urinary
as mentioned above, but the sensation, loss of desire to void,
Address for correspondence: principles of management apply in poor urinary stream and the need
Dr. Alan Gardner general to other aetiologies. to strain in order to micturate.
1 Hyde Lane Saddle and genital sensory deficit
Danbury Tandon and Sankaran
28
is often unilateral or partial.
Essex CM3 4QX described 3 variations of CES
01245 223456 (Tand S groups): Paradoxically, the patient may
adhg@btopenworld.com 1. Rapid onset without a previous become more comfortable as
history of back problems. painful bladder sensation fades
2. Acute bladder dysfunction with due to continuing cauda equina
a history of low back pain and compression. This is clearly an
sciatica. adverse development.
32 The Backcare Journal
backcare Winter 2009/10.indd 32 8/1/10 11:20:10
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