• Cauda Equina Syndrome

    (CES; Compression of Spinal Nerve Roots; Syndrome, Cauda Equina; Spinal Nerve Roots, Compression)


    Cauda equina syndrome (CES) is when the nerve roots at the base of the spinal cord are compressed. Known as the cauda equina, this bundle of nerves is responsible for the sensation and function of the bladder, bowel, sexual organs, and legs. CES is a medical emergency. If treatment is not started to relieve pressure on the nerves, function below the waist may be lost.
    Cauda Equina
    Copyright © Nucleus Medical Media, Inc.


    A common cause of CES is injury of a spinal disk on the nerve roots. A spinal disk is a semi-soft mass of tissue between the bones of the spine. These bones are known as the vertebrae. The disks act as the spine’s shock absorbers. When a disk spills out into the spinal canal, it can press against the bundle of nerves, causing CES. This syndrome may also be caused by:
    • Accident that crushes the spine, such as a car accident or fall
    • Penetrating injury, such as a knife or gunshot wound
    • Arthritis, such as ankylosing spondylitis
    • Complications from spinal anesthesia
    • Mass lesion, such as a blood clot
    • Complications from cancer
    • Side effect of certain medications

    Risk Factors

    Factors that may increase your risk of developing CES include:
    • History of back problems, such as lumbar spinal stenosis
    • Degenerative disk disease
    • Birth defects, such as a narrow spinal canal or spina bifida
    • Hemorrhages affecting the spinal cord
    • Arteriovenous malformation
    • Spinal surgery or spinal anesthesia
    • Lesion or tumor affecting the spinal bones, spinal nerve roots, or cerebrospinal fluid (CSF)
    • Infection affecting the spine
    • Manipulation of the lower back—rarely


    Symptoms may include:
    • Severe low back pain
    • Numbness or tingling in the crotch area known as saddle anesthesia/paresthesia
    • Inability to urinate, or to hold urine or feces
    • Inability to walk or dragging of foot
    • Weakness, loss of sensation, or pain in one or both legs
    • Sexual dysfunction; in men, the inability to maintain an erection


    You will be asked about your symptoms and medical history. A physical exam will be done. A neurological exam, which includes testing reflexes, vision, mental status, and strength, may also be done. A rectal exam may be done to assess sphincter function.
    Images may be taken of your bodily structures. This can be done with:
    Your muscle activity may be measured. This can be done with electromyography .


    Talk with your doctor about the best treatment plan for you. Treatment options include the following:
      Surgery options:
      • Laminectomy —a surgical procedure to remove a portion of a vertebra, called the lamina
      • Diskectomy —a surgical procedure to remove part of an intervertebral disk that is putting pressure on the spinal cord or nerve root
    • Radiation therapy —If CES is due to cancer, radiation therapy may be an option.
    Your doctor may also treat the underlying cause of CES.

    Follow-up Care

    The long-term effects of CES can range from mild to severe. Problems may include:
    • Difficulty walking
    • Problems with bladder and bowels
    • Sexual dysfunction
    • Paralysis
    Your follow-up care may involve working with a:
    • Physical therapist
    • Occupational therapist
    • Neurologist—doctor who specializes in the nervous system
    • Incontinence specialist—if you have lost bladder control


    Your doctor may prescribe medication for:
    • Pain
    • Bladder and bowel difficulties


    There is no way to prevent CES.


    Cauda Equina Syndrome Resource Center http://www.caudaequina.org

    Spinal Cord Resource Center—United Spinal Association http://www.spinalcord.org


    Canadian Spinal Research Organization http://www.csro.com

    Spinal Cord Injury Canada http://sci-can.ca


    Cauda equina syndrome. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00362. Updated March 2014. Accessed November 20, 2014.

    Cauda equina syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 20, 2014. Accessed November 20, 2014.

    Revision Information

  • LiveWell personal health survey

    How healthy are you really? Find out – free.Learn more

    It's time to stop guessing. If you want to make some changes but just aren't sure how, the free personal health survey from LiveWell is a great place to start.

  • HeartSHAPE Spotlight

    At risk for a heart attack? Learn more

    Fight heart disease and prevent heart attacks. HeartSHAPE® is a painless, non-invasive test that checks pictures of your heart for early-stage coronary disease.

  • Calories and Energy Needs

    Calorie NeedsLearn more

    How many calories do you need to eat each day to maintain your weight and fuel your physical activity? Enter a few of your stats into this calculator to find out.

  • Ideal Body Weight

    Ideal Body WeightLearn more

    Using body mass index as a reference, this calculator determines your ideal body weight range. All you need to do is enter your height.

  • Body Mass Index

    Body Mass IndexLearn more

    This tool considers your height and weight to assess your weight status.

  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.