European Spine Journal

, Volume 20, Issue 5, pp 690–697

Cauda equina syndrome: a review of the current clinical and medico-legal position

Review Article

DOI: 10.1007/s00586-010-1668-3

Cite this article as:
Gardner, A., Gardner, E. & Morley, T. Eur Spine J (2011) 20: 690. doi:10.1007/s00586-010-1668-3

Abstract

Cauda equina syndrome (CES) is a rare condition with a disproportionately high medico-legal profile. It occurs most frequently following a large central lumbar disc herniation, prolapse or sequestration. Review of the literature indicates that around 50–70% of patients have urinary retention (CES-R) on presentation with 30–50% having an incomplete syndrome (CES-I). The latter group, especially if the history is less than a few days, usually requires emergency MRI to confirm the diagnosis followed by prompt decompression by a suitably experienced surgeon. Every effort should be made to avoid CES-I with its more favourable prognosis becoming CES-R while under medical supervision either before or after admission to hospital. The degree of urgency of early surgery in CES-R is still not in clear focus but it cannot be doubted that earliest decompression removes the mechanical and perhaps chemical factors which are the causes of progressive neurological damage. A full explanation and consent procedure prior to surgery is essential in order to reduce the likelihood of misunderstanding and litigation in the event of a persistent neurological deficit.

Keywords

Cauda equina syndromeCentral disc prolapseBilateral sciaticaUrinary retentionPerineal hypoaesthesiaSexual dysfunction

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.South Essex University Hospitals and The Essex Spine CentreBrentwoodUK
  2. 2.Southampton General Hospital, Wessex Orthopaedic RotationSouthamptonUK
  3. 3.Royal National Orthopaedic HospitalStanmoreUK
  4. 4.EssexUK