Cauda equina syndrome

Signs & symptoms

• Back pain and/or leg pain plus any of the following in the last 14 days:
  • New (<14 days) or deteriorating difficulty initiating micturition or impaired sensation of urinary flow.
  • New (<14 days) or deteriorating altered perianal, perineal or genital sensation S2-S5 dermatomes (subjectively reports or objectively tested)
  • Severe or progressive neurological deficit of both legs, such as major motor weakness with knee extension, ankle eversion or foot dorsiflexion.
  • New (<14 days) or deteriorating loss of sensation of rectal fullness.
  • New (<14 days) or deteriorating sexual dysfunction (achievement of erection or ability to ejaculate, loss of genital sensation)

Risk factors

• Large herniated lumbar disc protrusion.
• History of spinal stenosis/ malignancy/ osteoporosis.
• Spina bifida.
• Congenitally narrow spinal canal.

Follow local cauda equina protocol.
If symptoms are acute or worsening within last 2 weeks contact on call orthopaedics/refer ED.
If stable symptoms and been present for over 2 weeks, safety net and refer urgently to Orthopaedics.

Musculoskeletal Association of Chartered Physiotherapists. Cauda equina information cards - for written patient information in different languages.

National Spine Network. Cauda equina syndrome framework.

NHS England. Getting it right first time. Interactive pathway for suspected cauda equina syndrome.