Originally written by: Jason Lauf, OMSII. Updated: June 29, 2022

Cauda equina syndrome is a serious medical condition that affects specific nerves in the lumbar spine region, which can cause permanent paralysis of the legs and bladder dysfunction.

Early diagnosis and treatment are critical to preventing these long-term complications. This article will provide an overview of CES, its symptoms, and some treatment methods.

The tail-like nerves which collect at the end of the spine are the cauda equina. It’s the root of the spinal nerve from the lumbar to the sacral region. It provides specific motor functions for your legs, bladder, and other pelvic organs.

Cauda equina syndrome occurs when the nerve roots that run through the spinal canal become compressed, resulting in early symptoms of pain, numbness, or weakness in the legs. In severe cases, it can lead to paralysis.

Causes of Cauda Equina Syndrome

Unfortunately, cauda equina syndrome (CES) can be challenging to diagnose, as many of its symptoms are similar to other medical conditions. Although it is more prominent in adults, children are not immune to developing CES if there is damage to these nerve endings.

The most common causes of cauda equina syndrome include:

Ruptured or herniated discs
Birth abnormalities in the affected areas
Spinal infections, inflammation, or hemorrhage
Lumbar spinal stenosis
Spinal tumors or lesions
Severe lower back injuries with permanent damage
Complications of lumbar spine surgery
CES can occur due to one or more of these reasons. Knowing the signs and symptoms can help you seek immediate medical attention if the condition worsens.

Signs and Symptoms of Cauda Equina Syndrome

The cauda equina nerves are a bundle of nerves at the base of the spinal cord in the lumbar region. They help control function in the legs, feet, and pelvic organs.

When damage occurs to these nerves from compression, it results in CES symptoms that can appear and interfere with daily activities, quickly becoming an emergency.

Cauda equina syndrome can happen gradually or suddenly, depending on its cause, although it is a medical emergency at any stage. Nevertheless, you can distinguish the severity of CES by some of the early symptoms that present themselves.

Depending on the level of compression, other symptoms of Cauda equina syndrome include:

Severe lower back pain
Sharp or stabbing sensations in the legs or lower extremities
Reduction of normal sensation in the lower limbs
Bowel incontinence
Saddle anesthesia (gradual onset of numbness in the groin and saddle area, and inner thighs)
Changes in sexual function
If you experience any of the above, it is recommended to seek immediate medical care. Cauda equina syndrome is considered a surgical emergency, and you should not delay diagnosis and treatment.

Saddle Paresthesia and How It Affects the Spinal Cord and Nerve Roots
Saddle paresthesia predominantly affects the saddle area, although the symptoms, such as numbness, are felt in the extremities (feet, legs, and hands) and the groin area.

It is caused by compression in the lower spine and cauda equina nerves, and it is frequently also a common symptom of cauda equina syndrome affecting the lower body.

Not every sufferer feels the same level of sensation. For example, many patients experience a numb but heavy feeling in the saddle area; some experience some tingling, while others may be completely free of any sensation.

Diagnosis and Treatment for Cauda Equina Syndrome

Physicians can diagnose CES from early symptoms using imaging tests like an MRI, neurological examination, or CT myelogram.

Doctors base the syndrome classification on whether the patient can stand up from the chairs with armrests or if they are experiencing urinary retention.

Treatment for cauda equina syndrome depends upon the underlying cause but may include physical therapy or treatment of severe symptoms. The surgical decompression of the saddle area has a high relief for symptoms and recovery rates.

The correlation between symptom persistence and the surgical expectation outcome will be the time from the start of symptoms to surgery.

Though more patients show better results when surgery happens within 72 hours of the onset of symptoms, the surgery is best performed within 24 hours of the onset of symptoms.

In some cases, decompression surgery, also known as a lumbar laminectomy, is the appropriate treatment to relieve pressure on the nerves within the spinal canal.

However, each situation is unique, and a physician may instead recommend a lumbar microdiscectomy to treat symptoms.


Cauda equina syndrome can occur due to numerous causes, including severe spinal trauma, spinal conditions, or a degenerative disc disease resulting from a herniated disc.

Unfortunately, the condition often does worsen over time, so seeking diagnosis and treatment from neurological surgeons as soon as possible is best for recovery.

Need to see a spine specialist? Schedule an appointment today at OrthoNeuro!

Frequently Asked Questions

How Can I Prevent Cauda Equina Disorder?

There is currently no way for a person to prevent the disease. You can only learn to recognize the symptoms of cauda equina and seek an accurate diagnosis for them.

Although it is impossible to stop it from happening, knowing the signs can direct you to seek medical care as soon as possible for recovery.

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