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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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).
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.
CES occurs due to compression of the nerve roots in your lumbar spine, most commonly caused by:
Rare causes include chiropractic manipulation, vertebral implants, or blood clots in the vena cava.
Risk factors for developing CES include:
CES can lead to severe and permanent complications, including:
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.
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.
Common CES symptoms include:
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.
CES is diagnosed using specialized imaging tests, including:
The only effective treatment for CES and CMS is surgical decompression of the affected nerves. Types of surgery include:
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.
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.
By UPMC Editorial Staff. Last reviewed on 2025-06-26.
