Cauda Equina Syndrome

Bryson Borg, MD

DIFFERENTIAL DIAGNOSIS

Common

Stenosis, Acquired Spinal, Lumbar
- Intervertebral Disc Herniation, Lumbar
- Spondylolisthesis
Trauma
- Burst Fracture, Lumbar
- Sacral Fracture (Zone 3)
- Traumatic Spondylolisthesis
- Penetrating Injury
Post-Operative Spinal Complications
Abscess, Epidural, Paravertebral
Neoplasm
- Metastases
- Ependymoma, Myxopapillary, Spinal Cord
- Meningioma
- Arachnoid Cyst
Hematoma, Epidural-Subdural

Less Common

Rare but Important

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Cauda equina syndrome (CES): Low back pain, sciatica, leg weakness, saddle hypoesthesia/anesthesia, urinary incontinence or retention, and incontinence of bowel
Substantial clinical overlap between the syndromes of the cauda equina and the conus medullaris
Most common cause is herniation of the intervertebral disc
MR or CT myelography are useful modalities to evaluate causes of CES
Acute onset CES generally considered a neurosurgical emergency, with best results if decompressed within 24-48 hours

Helpful Clues for Common Diagnoses

Intervertebral Disc Herniation, Lumbar
- CES occurs in approximately 1-2% of cases of herniated lumbar disc
- Most patients will have a long-standing history of back problems with or without unilateral sciatica
Post-Operative Spinal Complications
- Misplaced pedicle screw
- Displaced surgical device (fusion cage, graft material, artificial disc)
- Epidural hematoma or abscess
- Incomplete decompression
- Retained sponge