emDocs - June 13, 2021 - By John H. Priester, Mark Bisanzo
Reviewed by: Alex Koyfman and Brit Long
“Take Home Point
- Cauda equina syndrome (CES) is a rare but important diagnosis, as failure to recognize this disorder may result in delayed treatment and permanent neurologic deficits.
- CES results from compression of lower lumbar and sacral nerve roots, with L4-L5 disc herniation as the most common etiology.
- While CES is typically associated with low back pain, it also manifests with urinary retention, overflow bladder incontinence, constipation, bowel incontinence, saddle anesthesia, sexual dysfunction, sciatica, lower extremity weakness, and diminished lower extremity reflexes.
- Diagnosis of CES is primarily made by MRI.
- Point of care ultrasound to assess for urinary retention can be used to help guide the diagnosis of CES.
- Treatment of CES is by surgical decompression, with the best results occurring within 48 hours of symptom onset.
- CES may be missed by emergency providers if they fail to recognize the signs and symptoms that differentiate it from other sources of back pain. CES should be considered in the differential of all patients reporting back pain, urinary retention, incontinence, bowel dysfunction, sexual dysfunction, and lower extremity weakness.
- CES may also be missed in the emergency department if inappropriate imaging modalities are chosen. In the absence of absolute contraindications, MRI should be pursued in suspected cases instead of faster, less expensive choices such as plain films or CT.”