Cauda equina syndrome

Signs & symptoms

• Back pain with unilateral/bilateral radicular leg pain +/- paraesthesia and numbness plus:
  • Any new bladder or bowel disturbance.
  • Saddle paraesthesia/anaesthesia.
  • New altered sexual function.
  • Bilateral leg pain with normal neurology and no other CES symptoms – safety net and refer as per radicular pathway.

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.