Cauda Equina Syndrome

Cauda equina syndrome (CES) is a serious neurological condition caused by compression of the cauda equina, a bundle of nerves located in the lumbar (lower back) region of the spine.

This condition can lead to significant pain, sensory loss in your legs, and impaired function of your lower body organs. Prompt diagnosis and treatment are crucial to prevent permanent nerve damage and disability.

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On this page  

• What Is Cauda Equina Syndrome?
• What Are the Symptoms of Cauda Equina Syndrome?
• How Do You Diagnose Cauda Equina Syndrome?
• How Do You Treat Cauda Equina Syndrome?

What Is Cauda Equina Syndrome?  

Cauda equina syndrome (CES) results from compression of the cauda equina, a bundle of nerves located at the lower end of your spinal cord. These nerves control sensation and motor function in your lower body, including your legs, bladder, and bowels.

The cauda equina is situated in your lower spine, between your L1 and L5 vertebrae, near your coccyx (tailbone). The name "cauda equina," Latin for "horse's tail," comes from the nerve bundle's resemblance to a horse's tail.

Above your cauda equina, in the thoracic region of your spine, is your conus medullaris, another nerve bundle that contributes to lower body function. Compression or injury to the cauda equina or the conus medullaris can lead to CES or a similar condition known as conus medullaris syndrome (CMS).

What are the types of cauda equina syndrome? 

Although CES is a distinct neurological condition, CMS shares similar symptoms. However, they are separate conditions that affect different nerve regions and typically do not coexist.

What causes cauda equina syndrome?

CES occurs due to compression of the nerve roots in your lumbar spine, most commonly caused by:

• Aortic obstruction.
• Discitis (inflammation of your spinal discs).
• Herniated lumbar disc (responsible for approximately 45 percent of CES cases).
• Postoperative complications.
• Spinal infections of inflammation (e.g., meningitis, epidural abscess).
• Spinal stenosis (narrowing of your spinal canal).
• Spinal tumors or lesions.
• Trauma or direct injury to your lower spine.

Rare causes include chiropractic manipulation, vertebral implants, or blood clots in the vena cava.

What are cauda equina syndrome risk factors and complications?  

Cauda equina syndrome risk factors  

Risk factors for developing CES include:

• Congenital spinal abnormalities.
• Herniated lumbar disc.
• Previous spinal surgeries.
• Spinal infections.
• Spinal tumors.
• Trauma from falls, accidents, or sports injuries.

Complications of cauda equina syndrome

CES can lead to severe and permanent complications, including:

• Bladder and bowel dysfunction.
• Chronic pain.
• Permanent lower body weakness or paralysis.
• Sexual dysfunction (e.g., impotence).

How can I prevent cauda equina syndrome?

CES is often caused by sudden trauma or degenerative spinal conditions, so there are no guaranteed prevention methods. However, maintaining spinal health through regular exercise, proper posture, and avoiding high-impact injuries may reduce your risk.

How common is cauda equina syndrome? 

CES and CMS are rare, affecting approximately 1.5 to 3.4 million people worldwide each year. Herniated discs, the most common cause, result in CES in about 3 percent of cases.

Young men, who are more prone to traumatic spinal injuries, are at higher risk. In the U.S., around 1,000 new CES cases and 450 new CMS cases are diagnosed annually.

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What Are the Signs and Symptoms of Cauda Equina Syndrome? 

Common CES symptoms include:

• Severe lower back pain and sciatica.
• Bowel and bladder dysfunction (e.g., incontinence or retention).
• Saddle anesthesia (loss of sensation in the inner thighs, buttocks, and perineal area).
• Sexual dysfunction.
• Weakness or paralysis in the legs.

When should I see a doctor about my cauda equina syndrome symptoms? 

If you experience CES or CMS symptoms — particularly bowel or bladder dysfunction or sudden weakness — seek medical attention immediately. CES is a medical emergency requiring urgent intervention.

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How Do You Diagnose Cauda Equina Syndrome?

CES is diagnosed using specialized imaging tests, including:

• Bladder scan — May be used to assess urinary function.
• CT scan — Used in some cases, often with contrast dye or a lumbar puncture for better visualization.
• MRI — The preferred method to assess nerve compression and spinal abnormalities.

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How Do You Treat Cauda Equina Syndrome?  

The only effective treatment for CES and CMS is surgical decompression of the affected nerves. Types of surgery include:

• Laminectomy — Removal of part of the vertebra to relieve pressure on your nerves.
• Sequestrectomy — Removal of damaged or necrotic tissue affecting nerve function.

How effective is CES treatment?

Surgery is most effective when performed within 48 hours of symptom onset. Early intervention significantly improves recovery outcomes and reduces the risk of permanent damage. Delayed treatment may result in irreversible neurological deficits.

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Why Choose UPMC for CES Care?

UPMC is nationally recognized for excellence in spine care. We offer comprehensive care from diagnosis through treatment and beyond. Our team offers the most advanced nonsurgical and surgical care for a full range of spinal disorders and is engaged in pioneering research to develop novel treatment options.

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By UPMC Editorial Staff. Last reviewed on 2025-06-26.