NB THIS IS AN ACUTE EMERGENCY- PATIENTS REQUIRE URGENT SURGICAL MANAGEMENT.
Cauda equina syndrome is the result of a mass compression (usually from a massive ruptured disc, herniating in the midline; or a tumour) on the cauda equina, which is particularly sensitive to damage due to a poorly developed epineurium.
If a patient presents with back pain and any of these symptoms/signs (acutely/subacutely), referral to neurosurgery for decompression of the cauda equina should be made immediately (same day) to prevent permanent damage:
- Sphincter disturbances- urinary retention or incontinence; fecal incontinence
- Saddle anaesthesia- loss of sensation to the perineum and surrounding area
- Significant/progressive weakness of the lower limbs
- Severe bilateral sciatica
- Marked male sexual dysfunction