eMedicine Specialties > Emergency Medicine > Neurology

Cauda Equina Syndrome: Follow-up

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

Follow-up

Further Inpatient Care

  • Admit patients to appropriate service (usually neurology, neurosurgery, or orthopedic surgery) with frequent neurologic checks. Ideally, the admitting physician or service should examine the patient at the time of admission.

Further Outpatient Care

  • Patients in whom acute cauda equina syndrome (CES) is being considered should not be treated or investigated on an outpatient basis without evaluation by a consultant and/or appropriate imaging.

Transfer

  • Consider patients with CES for transfer if appropriate subspecialty care is not available.

Complications

  • Residual weakness, incontinence, impotence, and/or sensory abnormalities are potential problems if therapy is delayed.

Prognosis

  • The prognosis for CES improves if a definitive cause is identified and appropriate treatment occurs early in the course. Surgical decompression may be performed emergently, or, in some patients, delayed, depending on the etiology.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider the diagnosis of cauda equina syndrome in patients presenting with back pain and with bowel and/or bladder dysfunction
  • Failure to document history, neurologic examination, or comment on sphincter function in patients with back pain and possible cauda equina syndrome
  • Failure to consider possible spinal cord involvement with resulting disability
 


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

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  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].

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  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].

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  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].

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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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