eMedicine Specialties > Emergency Medicine > Neurology

Cauda Equina Syndrome: Differential Diagnoses & Workup

Author: Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
Contributor Information and Disclosures

Updated: Jun 17, 2009

Differential Diagnoses

Back Pain, Mechanical
Guillain-Barré Syndrome
Lumbar (Intervertebral) Disk Disorders
Neoplasms, Spinal Cord
Spinal Cord Infections
Spinal Cord Injuries

Other Problems to Be Considered

Conus medullaris syndrome
Spinal cord compression
Lumbosacral plexopathy
Peripheral nerve disorder

Workup

Imaging Studies

  • Plain radiography - Unlikely to be helpful in cauda equina syndrome but may be performed in cases of traumatic injury or in search of destructive changes, disk-space narrowing, or spondylolysis
  • CT with and/or without contrast - Lumbar myelogram followed by CT
  • MRI - Superiority of MRI over CT only suggested by case reports (Early consultation with the appropriate subspecialty is encouraged to guide imaging studies.)7
  • Ultrasonography may be used to estimate or measure post-void residual volume.

Other Tests

  • Catheterization for residual urine volume may reveal urinary retention suggesting a neurogenic bladder.

More on Cauda Equina Syndrome

Overview: Cauda Equina Syndrome
Differential Diagnoses & Workup: Cauda Equina Syndrome
Treatment & Medication: Cauda Equina Syndrome
Follow-up: Cauda Equina Syndrome
Multimedia: Cauda Equina Syndrome
References
Further Reading
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References

  1. Mauffrey C, Randhawa K, Lewis C, Brewster M, Dabke H. Cauda equina syndrome: an anatomically driven review. Br J Hosp Med (Lond). Jun 2008;69(6):344-7. [Medline].

  2. Bell DA, Collie D, Statham PF. Cauda equina syndrome: what is the correlation between clinical assessment and MRI scanning?. Br J Neurosurg. Apr 2007;21(2):201-3. [Medline].

  3. Ma B, Wu H, Jia LS, Yuan W, Shi GD, Shi JG. Cauda equina syndrome: a review of clinical progress. Chin Med J (Engl). May 20 2009;122(10):1214-22. [Medline].

  4. Todd NV. An algorithm for suspected cauda equina syndrome. Ann R Coll Surg Engl. May 2009;91(4):358-9; author reply 359-60. [Medline].

  5. Olivero WC, Wang H, Hanigan WC, Henderson JP, Tracy PT, Elwood PW, et al. Cauda equina syndrome (CES) from lumbar disc herniations. J Spinal Disord Tech. May 2009;22(3):202-6. [Medline].

  6. Widge AS, Tomycz ND, Kanter AS. Sacral preservation in cauda equina syndrome from inferior vena cava thrombosis. J Neurosurg Spine. Mar 2009;10(3):257-9. [Medline].

  7. Rooney A, Statham PF, Stone J. Cauda equina syndrome with normal MR imaging. J Neurol. May 2009;256(5):721-5. [Medline].

  8. [Guideline] Institute for Clinical Systems Improvement (ICSI). Adult low back pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2008 Nov. [Full Text].

  9. [Guideline] Michigan Quality Improvement Consortium. Management of acute low back pain. Southfield (MI): Michigan Quality Improvement Consortium; 2008 Mar. [Full Text].

  10. [Guideline] Bussieres AE, Taylor JA, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults-an evidence-based approach-part 3: spinal disorders. J Manipulative Physiol Ther. Jan 2008;31(1):33-88. [Medline]. [Full Text].

  11. Ahn UM, Ahn NU, Buchowski JM, et al. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine. Jun 15 2000;25(12):1515-22. [Medline].

  12. Boukobza M, Guichard JP, Boissonet M, et al. Spinal epidural haematoma: report of 11 cases and review of the literature. Neuroradiology. Aug 1994;36(6):456-9. [Medline].

  13. Busse JW, Hsu WS. Rapid progression of acute sciatica to cauda equina syndrome. J Manipulative Physiol Ther. Jun 2001;24(5):350-5. [Medline].

  14. Choudhury AR, Taylor JC. Cauda equina syndrome in lumbar disc disease. Acta Orthop Scand. Jun 1980;51(3):493-9. [Medline].

  15. Cohen MS, Wall EJ, Kerber CW, et al. The anatomy of the cauda equina on CT scans and MRI. J Bone Joint Surg Br. May 1991;73(3):381-4. [Medline].

  16. Davis DP, Bruffey JD, Rosen P. Coccygeal fracture and Paget's disease presenting as acute cauda equina syndrome. J Emerg Med. Mar-Apr 1999;17(2):251-4. [Medline].

  17. Delamarter RB, Sherman JE, Carr JB. 1991 Volvo Award in experimental studies. Cauda equina syndrome: neurologic recovery following immediate, early, or late decompression. Spine. Sep 1991;16(9):1022-9. [Medline].

  18. Gleave JR, Macfarlane R. Cauda equina syndrome: what is the relationship between timing of surgery and outcome?. Br J Neurosurg. Aug 2002;16(4):325-8. [Medline].

  19. Hall ED. The neuroprotective pharmacology of methylprednisolone. J Neurosurg. Jan 1992;76(1):13-22. [Medline].

  20. Hussain SA, Gullan RW, Chitnavis BP. Cauda equina syndrome: outcome and implications for management. Br J Neurosurg. Apr 2003;17(2):164-7. [Medline].

  21. Kaiboriboon K, Olsen TJ, Hayat GR. Cauda equina and conus medullaris syndrome in sarcoidosis. Neurologist. May 2005;11(3):179-83. [Medline].

  22. Mohit AA, Fisher DJ, Matthews DC, et al. Inferior vena cava thrombosis causing acute cauda equina syndrome. Case report. J Neurosurg. Jan 2006;104(1 Suppl):46-9. [Medline].

  23. Rigler ML, Drasner K, Krejcie TC, et al. Cauda equina syndrome after continuous spinal anesthesia. Anesth Analg. Mar 1991;72(3):275-81. [Medline].

  24. Rydevik B. Neurophysiology of cauda equina compression. Acta Orthop Scand Suppl. 1993;251:52-5. [Medline].

  25. Rydevik B, Brown MD, Lundborg G. Pathoanatomy and pathophysiology of nerve root compression. Spine. Jan-Feb 1984;9(1):7-15. [Medline].

  26. Small SA, Perron AD, Brady WJ. Orthopedic pitfalls: cauda equina syndrome. Am J Emerg Med. Mar 2005;23(2):159-63. [Medline].

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Further Reading

Clinical guidelines

 Adult low back pain.
Institute for Clinical Systems Improvement - Private Nonprofit Organization. 2008 Nov. 66 pages.  NGC:006888

Management of acute low back pain.
Michigan Quality Improvement Consortium - Professional Association. 2008 Mar. 1 page.  NGC:006422

Diagnostic imaging practice guidelines for musculoskeletal complaints in adults - an evidence-based approach. Part 3: spinal disorders.
Bussieres AE, Taylor JA, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults-an evidence-based approach-part 3: spinal disorders. J Manipulative Physiol Ther 2008 Jan;31(1):33-88. [422 references] PubMed.  NGC:006703

Clinical trials

IDE Clinical Trial Comparing Coflex vs. Fusion to Treat Lumbar Spinal Stenosis

World Health Organization Disability Assessment Schedule (WHODAS-II) for Patients With Symptomatic Lumbar Disc Herniation

Surgical Treatment Comparison for Recurrent Lumbar Disc Herniation


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Keywords

cauda equina syndrome, CES, lumbosacral nerve root compression, sciatica, neuromuscular disorders, urogenital disorders, nerve compression, ankylosing spondylitis, bladder dysfunction, bowel dysfunction, herniated disk, disk herniation, spinal stenosis, spinal neoplasm, spinal tumor, low back pain, spinal column, narrowing of the spinal canal, spinal nerves, spinal cord, vertebral column, laminectomy, discectomy, compression of nerve roots, inflammation of nerve roots, CE syndrome, saddle sensory disturbances, variable lower extremity motor loss, variable lower extremity sensory loss, radiating pain, perineal anesthesia, incontinence, painradiating to legs, poor anal sphincter tone, lumbar disc disease, spinal anesthesia, late-stage ankylosing spondylitis

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Contributor Information and Disclosures

Author

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Kirsten A Bechtel, MD, Associate Professor, Department of Pediatrics, Yale University School of Medicine; Attending Physician, Department of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital
Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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