Cauda equina syndrome: the spine emergency that cannot wait

Almost all lower back pain can be dealt with calmly. Cauda equina syndrome is one of the few exceptions: it is an emergency that cannot wait.

What is cauda equina syndrome?

It is severe compression of the bundle of nerve roots that run down the last part of the spine, called the cauda equina or "horse's tail." These roots control sensation and strength in the legs, the bladder, the bowel and sexual function.

What causes it?

Most often, a large lumbar herniated disc that suddenly fills the canal. It can also be caused by severe stenosis, a hematoma, an infection, a tumor or a fracture. What matters most is how much compression there is and how long it lasts.

What are the warning symptoms?

• Changes in urination: trouble starting, a feeling of not emptying the bladder, leaking or being unable to urinate.
• Loss of bowel control or not feeling bowel movements pass.
• "Saddle" numbness: the inner thighs, genitals and the area around the anus.
• Weakness in one or both legs, trouble walking or lifting the foot.
• Severe lower back pain that runs down both legs.

The combination of lower back pain with changes in bladder or bowel control, or numbness in that area, is what makes it an emergency.

What should I do if I have these symptoms?

Go to the emergency room immediately; do not wait for an appointment. Prolonged compression can leave lasting damage to urinary and bowel function and strength, and recovery depends greatly on how quickly the pressure is relieved.

How is it diagnosed and treated?

In the emergency room, a neurological exam and an MRI are done to confirm the diagnosis and locate the compression. If it is confirmed, the usual treatment is surgery to decompress the roots.

Is it common?

No. The vast majority of lower back pain is not cauda equina. Knowing its signs helps you recognize the difference and act without delay if they appear.

In summary

Back pain with changes in urination or bowel movements, or numbness in the saddle area: go to the emergency room immediately.

This article is for information only and does not replace a medical visit. If you have warning signs, go to the emergency room.