Overview
Cauda equina syndrome (CES) is a surgical emergency characterized by compression of the nerve roots in the lumbar sac. Symptoms can include severe low back pain, saddle anesthesia, bilateral sciatica, and motor or sensory deficits in the lower extremities. While CES often presents with bladder dysfunction, it can occur without overt urinary symptoms.Diagnosis
CES is a clinical diagnosis based on neurological deficits 1.
Key symptoms include severe low back pain, saddle anesthesia, bilateral radiculopathy, and motor/sensory deficits 1.
Bladder dysfunction (urinary retention, incontinence) is a common but not universal feature 1.
Urgent MRI of the lumbar spine is the imaging modality of choice to confirm the diagnosis and identify the level of compression 1.Management
Surgical decompression is the definitive treatment for CES 1.
The goal of surgery is to relieve pressure on the cauda equina nerve roots 1.
Timing of surgery is critical, with outcomes generally better when performed within 24-48 hours of symptom onset 1.Key Recommendations
Surgical decompression should be performed urgently in patients with CES 1. (Evidence: Strong)
MRI of the lumbar spine is recommended for diagnosis and localization of the compression 1. (Evidence: Strong)
While bladder dysfunction is common, CES can occur without overt urinary symptoms, and diagnosis should not be delayed if other CES signs are present 1. (Evidence: Expert opinion)References
1 Farag F, Sakalis VI, Arteaga SM, Sihra N, Karavitakis M, Arlandis S et al.. What Are the Short-term Benefits and Potential Harms of Therapeutic Modalities for the Management of Overactive Bladder Syndrome in Women? A Review of Evidence Under the Auspices of the European Association of Urology, Female Non-neurogenic Lower Urinary Tract Symptoms Guidelines Panel. European urology 2023. link