Patients initially present with lower back pain in almost all cases, usually with sciatica and pain in the genitalia and rectum [10]. Impaired sphincter function occurs in 15-30% of patients [10].

The clinical picture of cauda equina syndrome includes [2] [13]:

• Lower back pain 
• Neurological deficits (distal motor weakness, sensory disturbance in the legs, numbness and pain, absent lower-limb reflexes)
• Urological symptoms (bladder and bowel incompetence, impotence may occur with erectile dysfunction due to the lack of sensation in pubic area [14])
• Scoliosis and foot deformities. 

Diagnosis and treatment are often delayed because the symptoms are not recognized immediately [6]. Cauda equina syndrome may present as acute, sub-acute or insidious [1] [4] [15]. The precipitating factor in the acute form may be traumatic injury or movements as simple as stooping, with or without heavy lifting [15].

Urinary manifestations include the following [4] [7]:

• Retention
• Difficulty initiating micturition
• Decreased urethral sensation

Bowel disturbances may include the following [7]:

• Incontinence
• Constipation
• Loss of anal tone and sensation

Complications include [4]:

• Thromboembolic phenomena
• Neurogenic bladder/bowel
• Erectile dysfunction
• Pressure ulcers
• Osteoporosis
• Chronic neuropathic pain
• Spasticity/contractures
• Recurrent urinary tract infections
• Bladder calculi

• Pain

  Reviewing with the Staff This is a great tip for learners to have to help them remember what to screen for when discussing symptoms with back pain patients. [canadiem.org]

  Despite the late- diagnosed cauda equina syndrome, we observed that surgical decompression and lumbopelvic fixation had positive effects on neurologic recovery, pain relief and early unsupported mobilization. [ncbi.nlm.nih.gov]

  30% of patients may present without back pain These patients may present with a sudden onset of numbness that may escalate, leg weakness or difficulty walking.3 Pain, when present, is often severe and difficult to control. [cmaj.ca]

  pain, and loss of perineal sensation is uni- or bi-lateral). [bjgp.org]

  […] alone or even back pain in combination with lower extremity pain. [ahcmedia.com]

• Weakness

  Abstract In the first prospective comparison of 'scan-negative' (n=11) and 'scan-positive' (n=7) patients with cauda equina syndrome (CES) we found that Hoover's sign of functional leg weakness but not routine clinical features differentiated the two [ncbi.nlm.nih.gov]

  Category: Orthopedics Take Home Points: Cauda equina syndrome is a rare emergency with devastating consequences Early recognition is paramount as the presence of bladder dysfunction portends bad functional outcomes The presence of bilateral lower extremity weakness [rebelem.com]

  Cauda Equina Syndrome Clinical Evaluation Severe bilateral leg pain, weakness, saddle anesthesia (perianal numbness), bowel/bladder symptoms (urninary retention early, urine/bowel incontinence late), impotence (sexual dysfunction). [eorif.com]

  Practice CMAJ March 01, 2016 188 (4) 284; DOI: https://doi.org/10.1503/cmaj.150206 Cauda equina syndrome is a complex of low-back pain, bilateral sciatica, saddle anesthesia and motor weakness in the lower extremities1 The syndrome can progress to paraplegia [cmaj.ca]

• Falling

  METHODS: A 37-year-old male had a penetrating rectal injury by a long steel bar as a result of a falling accident. He was firstly treated with removal of the bar, debridement, and fecal diversion. [ncbi.nlm.nih.gov]

  It is akin to a fall on the back or neck, due to its ability to lead to permanent paralysis if left untreated. [spinalcord.com]

  Causes: Children born with abnormalities that cause Cauda Equina Fracture Infection Narrowing of the spinal canal Ruptured disc Trauma (car accident, gunshot, fall, etc.) [anaheimregionalmc.com]

  Victims of automobile accidents, falls, and other trauma may develop cauda equina syndrome. [virginiatrialfirm.com]

• Swelling

  However, as a result of its hydrophilic properties, DuraSeal(™) has the potential to swell, which could lead to compression of the thecal sac. [ncbi.nlm.nih.gov]

  Many of these conditions cause swelling, which contributes to compression of the nerves. [merckmanuals.com]

  It may be damaged by an injury or swell because it becomes inflamed (as occurs in ankylosing spondylitis). The symptoms that result are called the cauda equina syndrome. [msdmanuals.com]

• Lower Extremity Pain

  A 37-year-old woman, with history of intravenous drug abuse, hepatitis C, and hepatitis B, presented with low back pain lasting 2 months, lower extremity pain, left greater than right with increasing weakness and difficulty ambulating, and urinary and [ncbi.nlm.nih.gov]

  The weakness can affect lower extremities. Pain in the back and/or legs (also known as sciatica). Sexual dysfunction. [aans.org]

  Quint et al. reported a case with MM who had presented with a 1- week history of progressive bilateral lower extremity pain and weakness [8]. Our patient was presented with CES and diagnosed MM with cauda equina involvement. [oatext.com]

  Cauda equina syndrome[22] - Lower extremity pain, weakness, numbness that may involve perineum and buttocks, associated with bladder and bowel dysfunction. [en.wikipedia.org]

• Fecal Incontinence

  I cannot help but emphasize one how important it is to realize that it is URINARY RETENTION and FECAL INCONTINENCE that are hallmarks of this syndrome. [canadiem.org]

  After catheter removal, the patient developed urinary retention, fecal incontinence, and perianal hypoesthesia. [ncbi.nlm.nih.gov]

• Abdominal Pain

  There is little in literature regarding abdominal pain as a significant feature of the initial presentation of CES. [ncbi.nlm.nih.gov]

  Patients suffering from diverticulitis usually complain of left lower quadrant abdominal pain and alterations in their defecation pattern. Fever, chills and urinary urgency are common as well [ 3 ]. [karger.com]

• Diarrhea

  However, extreme constipation causing impaction of feces can lead to overflow of diarrhea around the impacted fecal mass. [caudaequina.org]

  Extreme constipation; however, which causes impaction of feces may lead to overflow of diarrhea around the impacted fecal mass. Most commonly in cauda Equina syndrome, it is hard for the person to empty their bowel. [disabled-world.com]

• Blister

  Diagnosis typically involves electromyography and lumbar puncture.[12] Shingles is more common among the elderly and immunocompromised; typically, pain is followed by the appearance of a rash with small blisters along a single dermatome.[12][28] Acute [en.wikipedia.org]

• Back Pain

  Reviewing with the Staff This is a great tip for learners to have to help them remember what to screen for when discussing symptoms with back pain patients. [canadiem.org]

  30% of patients may present without back pain These patients may present with a sudden onset of numbness that may escalate, leg weakness or difficulty walking.3 Pain, when present, is often severe and difficult to control. [cmaj.ca]

  DOI: https://doi.org/10.3399/bjgp14X676988 BACKGROUND Back pain is common in primary care. [bjgp.org]

  pain alone or even back pain in combination with lower extremity pain. [ahcmedia.com]

  Back pain prevalence in the pediatric age group is less compared with adults. There is a wide range of possible etiologies, and tumors such as primary spinal hemangiomas are uncommon. [ncbi.nlm.nih.gov]

• Low Back Pain

  […] with rectal and urinary incontinence and represents a surgical emergency.1 Sixty percent of patients are male with a mean age of 42 years, and 82% have a history of chronic low-back pain. [cmaj.ca]

  A 37-year-old woman, with history of intravenous drug abuse, hepatitis C, and hepatitis B, presented with low back pain lasting 2 months, lower extremity pain, left greater than right with increasing weakness and difficulty ambulating, and urinary and [ncbi.nlm.nih.gov]

• Buttock Pain

   Convoy machine gunner  Prolonged periods of standing >8 hrs  Wearing equipment up to ~80 lbs  4 week history of insidious onset and recent worsening of:  Low back pain  Left buttock pain  Posterior left thigh pain  Goal: Decrease pain during [slideshare.net]

  […] relieved by rest.[14] Piriformis syndrome[edit] Piriformis syndrome is a condition that, depending on the analysis, varies from a "very rare" cause to contributing up to 8% of low back or buttock pain.[15] In 17% of people, the sciatic nerve runs through [en.wikipedia.org]

• Sciatica

  The patient was treated with analgesia and given advice to seek review if she developed bilateral sciatica, became incontinent, or developed leg weakness. [bmj.com]

  Compared to average diameters in literature, diameters of CES patients were significantly more often below average than that of the sciatica patients (largest p = 0.021). [ncbi.nlm.nih.gov]

  After age 50, sciatica is more commonly caused by spinal stenosis than disk herniation. Most of the time, sciatica from a herniated disk resolves within six weeks with little or no treatment. [healthcommunities.com]

• Foot Drop

  CES can lead to pain, numbness, and weakness in the lower back, pelvic area and legs; " foot drop "; problems with bowel or bladder control; sexual dysfunction; and even paralysis. [rarediseases.info.nih.gov]

  Most of the symptoms resolved within a few days, but right side foot drop persisted for 2 years after the procedure. [ncbi.nlm.nih.gov]

  There may be "foot drop" where the foot drags and causes trips and falls. In some cases it may be necessary to use walking aids or a wheelchair. [caudaequina.org]

  Sore Feet: Loss of muscle tone and control over movement of the foot may lead to foot pain. If foot drop is a notable issue, a brace to hold it in position may help. [disabled-world.com]

  Patient 4 is a 65-year-old male with almost 40 years of AS who presented with left foot drop associated with pain, numbness, weakness, and muscle atrophy over 4 years in duration. [jrheum.org]

• Limb Weakness

  […] thighs and lower groin Weakness of the lower limbs Reduced or absent lower limb reflexes Decreased urinary urgency with no incontinence Urinary or bowel retention or incontinence Causes There are many possible causes of Cauda Equina Syndrome. [norellehealth.com]

  In this paper, patient with myeloma in plateau phase had been presented with a short history (less than 12 h) of low back pain, parasthesia and lower limb weakness. [oatext.com]

  The clinical signs characteristic of the pathology are: severe back pain, often accompanied by sciatica; saddle anesthesia 4, 5 ; sphincter and sexual dysfunction; and lower limb weakness. 6, 7, 8 The presence of all these signs simultaneously is not [ncbi.nlm.nih.gov]

• Spinal Cord Syndrome

  Other causes include congenital neurologic anomalies (eg, spina bifida), spinal cord infection, spinal epidural abscess, spinal cord tumor, spinal cord trauma, spinal stenosis, arteriovenous malformation, and complications after spinal surgery. [merckmanuals.com]

  […] the 2 syndromes are often not available separately from the general data on spinal cord injury. [emedicine.medscape.com]

• Numbness in the Buttocks

  He also complained of newly developed numbness in the buttocks, groins, and perineum, and difficulty with urination and defecation, after repeated caudal epidural injections during a 3-week period. [ncbi.nlm.nih.gov]

  It can cause pain in the lower back and/or legs, weakness in one or both legs, numbness in the buttocks, between inner thighs/in or around your back passage (the ‘saddle region’) or in legs. [cic.circlehealthgroup.co.uk]

• Incontinence

  I cannot help but emphasize one how important it is to realize that it is URINARY RETENTION and FECAL INCONTINENCE that are hallmarks of this syndrome. [canadiem.org]

  (4) 284; DOI: https://doi.org/10.1503/cmaj.150206 Cauda equina syndrome is a complex of low-back pain, bilateral sciatica, saddle anesthesia and motor weakness in the lower extremities1 The syndrome can progress to paraplegia with rectal and urinary incontinence [cmaj.ca]

  Urinary or fecal retention are as common as incontinence 4 Urinary symptoms (largely S2-mediated) can include altered urethral sensation, loss of desire to void, poor stream, feeling of retention and straining to void. [dx.doi.org]

  – up to 92% (Korse 2017) Disruption of autonomic innervation leads to retention and overflow incontinence Bowel dysfunction (constipation and/or incontinence) – up to 74% (Korse 2017) Decreased sensation in the perianal area – up to 93% (Korse 2017) [rebelem.com]

• Urinary Retention

  I cannot help but emphasize one how important it is to realize that it is URINARY RETENTION and FECAL INCONTINENCE that are hallmarks of this syndrome. [canadiem.org]

  QID: 3770 Leg pain > urinary retention > urinary incontinence Urinary retention > leg pain > absent ankle jerk Urinary retention > leg pain > urinary incontinence Leg pain > urinary incontinence > urinary retention Reduced rectal tone > urinary retention [orthobullets.com]

  Cauda equina syndrome (like conus medullaris syndrome) causes distal leg paresis and sensory loss in and around the perineum and anus (saddle anesthesia), as well as bladder, bowel, and pudendal dysfunction (eg, urinary retention, urinary frequency, urinary [merckmanuals.com]

• Sexual Dysfunction

  Left untreated patients may develop permanent bowel, bladder and sexual dysfunction with severe personal and social implications. [eorif.com]

  Dysfunction at follow up was highly prevalent: 38% micturition dysfunction, 43% defecation dysfunction and 54% sexual dysfunction. [ncbi.nlm.nih.gov]

  Cauda Equina Syndrome: presentation, outcome and predictors with focus on micturition, defecation and sexual dysfunction. Eur Spine J 2017; 26(3): 894-904. [rebelem.com]

• Urinary Incontinence

  Urinary incontinence from cauda equina syndrome may be reversible Surgical treatment within 48 hours after onset brings a 70% probability that lost bladder function will be regained at two years; with delayed care, the probability is only 40%.2 Up to [cmaj.ca]

  Our patient underwent emergency neurosurgical spinal decompression, which resolved most symptoms, except for mild urinary incontinence. [ncbi.nlm.nih.gov]

  Patients may present with back pain, unilateral or bilateral leg pain, paresthesias and weakness, perineum or saddle anesthesia, and rectal and/or urinary incontinence or dysfunction. [doi.org]

  Urinary or fecal retention are as common as incontinence 4 Urinary symptoms (largely S2-mediated) can include altered urethral sensation, loss of desire to void, poor stream, feeling of retention and straining to void. [dx.doi.org]

The diagnosis of cauda equina syndrome is usually made by history and physical findings [7]. Patients who present with bowel or bladder disturbances, leg weakness, or rectal and genital sensory deficits should be evaluated [7] [16]. Radiologic and laboratory studies help to confirm the diagnosis and identify the pathology and underlying cause [1] [13]. Magnetic resonance imaging is the most effective means of definitive diagnosis [7] [13]. Urgent magnetic resonance imaging should be obtained in all patients with lumbar back pain and new onset urinary symptoms [7] [17]. However, magnetic resonance imaging may be normal in as many as 43% of patients with suspected cauda equina syndrome [7]. Magnetic resonance imaging with gadolinium contrast has improved results [7]. 

Other examinations include [4] [7]:

• Myelography
• Computed tomography 
• Bone scans can detect malignant tumors and inflammation of the vertebrae

Laboratory studies may include [1] [3]:

• Basic blood tests, chemistries, fasting blood sugar
• Erythrocyte sedimentation rate
• Renal function
• Syphilis and Lyme serology
• Cerebrospinal fluid examination

Other procedures

• Needle electromyography can show acute denervation and predict outcome and monitor recovery [1] [7]. 
• Somatosensory evoked potentials can be used to rule out multiple sclerosis [1]. 
• Inflammatory or infective diseases of the meninges or spinal cord are ruled out using lumbar puncture [1] [14].

No proven medical treatment exists for the treatment of cauda equina syndrome. Therapy needs to be individualized and directed toward the underlying cause of the syndrome [11]. Since compression of the lower spinal column is the primary cause of cauda equina syndrome, surgical decompression is the primary treatment for the condition [17]. The major factors effecting operative outcome include [10] [17]:

• The severity of the sphincter dysfunction
• The extent of sensory loss
• Early diagnosis and surgical intervention

Early diagnosis, evaluation by a neurosurgeon, and surgical decompression should be instituted before the neurological damage becomes permanent [4] [10]. The onset of bladder paralysis is the most important indication for immediate surgery [3]. Laminectomy and discectomy are the recommended treatment and should be an emergency intervention [8] [17]. Posterior decompression and stabilization offers the best neurological outcomes [11]. Surgery is recommended within 48 hours, but newer studies failed to see a correlation between the timing of surgery and the outcomes [3] [8] [15] [17].

Medications

Treatment with pharmaceuticals may include [11]:

• Antibiotics to treat cauda equina syndrome due to infections
• Antiinflammatories, steroids and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce or prevent swelling
• Chemotherapy for the treatment of neoplastic tumors

Other therapy

Rehabilitation post-surgery should include physical and occupational therapy. The goal is a return to independent activities of daily living and the maintenance of and improvement of strength and endurance [9] [10]. Prevention and treatment of possible complications, especially deep venous thrombosis, bladder and bowel problems, and decubitus ulcers, should also be part of any treatment plan.

Patients who have had cauda equina syndrome often do not return to a normal status [12]. Prognosis for recovery is improved when the cause of the disorder is identified early and appropriate treatment instituted [9]. Residual weakness, incontinence, impotence, and/or sensory abnormalities are potential problems if therapy is delayed [1] [6].

Patients with bladder incontinence or retention regain continence post-surgery in over 90% of cases [5] [8]. Outcomes postoperatively are worse in patients with bowel dysfunction [5] [10]. Morbidity and mortality rates depend on the underlying etiology [1] [8]. Increased age is also associated with poorer postoperative outcomes [6].

Cauda equina syndrome is caused by a narrowing of the spinal canal that results in compression of the nerve roots below the spinal cord, the cauda equina [3]. The cauda equina provides sensory innervation to the saddle area, motor innervation to the urinary and anal sphincters, parasympathetic innervation to the bladder and lower bowel, and sensation and motor control to the lower extremities [3] [5].

The most common causes of caudal equina syndrome include acute disc herniation or traumatic injury at the terminal portion of the spinal cord [2] [7], tumors (malign or benign), or infection [7]. Herniated lower lumbar or sacral discs are the most common cause [1] [4] [7]. Cauda equina syndrome is an emergency [1] requiring immediate diagnosis (usually with magnetic resonance imaging) and surgical intervention [5]. The onset of symptoms in cauda equina syndrome may be acute or may have a gradual onset [7]. The gradual onset has a better prognosis. The outcome of the disorder depends on how quickly it is diagnosed and treated [8].

Individuals with congenital developmental abnormalities or degenerative conditions, such as ankylosing spondylitis, spondylosis, and spondylolisthesis, are more likely to develop cauda equina syndrome, because narrowing already exists [9].  Complications of the condition may include bowel and bladder dysfunction, lower extremity sensory loss, and lower extremity paralysis [1] [10].

Common causes of cauda equina syndrome include [3] [2] [8] [11]:

• Disc herniation
• Intradural disc rupture
• Spinal stenosis
• Traumatic injury, fracture or subluxation
• Primary and metastatic tumors
• Infections
• Hemorrhage or emboli
• Iatrogenic injury resulting from complications of spinal surgery or spinal anesthesia

Other, rare causes include the following [3] [8]:

• Spinal hemorrhage
• Congenital anomalies of the spine
• Multiple sclerosis
• Spinal arteriovenous malformations
• Late-stage ankylosing spondylitis
• Neurosarcoidosis
• Deep venous thrombosis of the spinal veins

Cauda equina syndrome is rare [4] [7]. The incidence is variable and depends on the etiology of the syndrome [7]. Mean age at onset of cauda equina syndrome is 41 years of age (24-67 years) but it can occur at any age [12]. Cauda equina syndrome due to traumatic injury is not age specific. Non-traumatic forms of cauda equina Syndrome occur primarily in adults [12]. Cauda equina syndrome, secondary to disk herniation, is most common in men 40 -to50 years of age [6]. The incidence is not affected by gender or race. Males and females are equally affected [7] [12].

Cauda equina syndrome results from injury to the lumbosacral nerve roots at the end of the spinal cord below the tip of the conus medullaris [1]. The spinal cord connects the peripheral and spinal nerves to the brain. The cauda equina provides the connection of the spinal cord to the lower peripheral nervous system [1]. It is a purely lower motor neuron injury [11].

Compression of the nerve fibers results in increased vascular permeability and subsequent diffusion of cerebral spinal fluid. This causes edema which accentuates the mechanical compression [1] [11]. The symptoms are due to compression, displacement, entrapment, or trauma to the cauda equina [9]. The level of spinal injury and the initial cause of compression affect the symptomatology and outcome [11]. Symptoms depend on which roots of the cauda equina are involved [9].

Tethered spinal cord is a cause of cauda equina syndrome seen more in children, but also occurs in adults [13]. This is due to a congenital abnormality, a tight, thickened, shortened filum terminale, intradural scar formation, or other lesion, that leads to fixation of the lower spinal cord [11] [13]. Movement of the spinal cord is impaired and leads to chronic local ischemia, swelling, and compression [1] [13].

Compression of the cauda equina can result in decreased sensation to the saddle area, paralysis of bowel and bladder sensation and function, sensory loss and motor dysfunction of the lower extremities [1] [10] [13].

Differential diagnoses include [9] [11] [13]:

• Amyotrophic lateral sclerosis
• Diabetic neuropathy
• Guillain-Barré Syndrome
• HIV-1 associated neuromuscular complications
• Multiple sclerosis
• Neoplasms of spinal cord
• Neurosarcoidosis
• Spinal cord infections
• Traumatic peripheral nerve lesions

Prevention of lower spinal injury is the only way to prevent the syndrome. Prevention of cauda equina syndrome depends upon the early identification of lower spine defects that may result in compression of the nerve roots. Immediate intervention to relieve the compression improves the progression and the occurrence of complications [10].

Cauda equina syndrome is a rare disorder characterized by a group of symptoms resulting from compression of the nerve roots of the cauda equina [1] [2]. The cauda equina, Latin for ‘horse's tail’, is a collection of nerve roots located at the end of the spinal cord at the first and second lumbar vertebrae [1] [3]. The symptoms of the disorder are due to damage to nerve fibers due to compression and ischemia. Onset may be sudden or gradual. Symptoms include low back pain, sciatica, saddle sensory loss, bladder and bowel dysfunction, and lower extremity motor dysfunction [1] [3] [4]. Damage may be irreversible [1].

Cauda equina syndrome is considered a surgical emergency [1] and surgical intervention to relieve nerve compression is the most effective treatment [1] [5]. The causes of the condition are varied, but the most common causes are a displaced herniated disc or traumatic injury to the lumbar or sacral vertebrae [3] [5] [6].

What is cauda equina syndrome?

Cauda equina syndrome is a rare group of symptoms resulting from compression of the nerve roots located at the end of the spinal cord at the level of the first and second lumbar vertebrae. It results from injury to the spinal cord or vertebrae due to a herniated disk or trauma.

What are the symptoms of cauda equina syndrome?

Symptoms include low back pain, sciatica, saddle sensory loss, bladder and bowel dysfunction, and lower extremity motor disability. Onset may be sudden or gradual. Damage may be irreversible.

What causes cauda equina syndrome?

The symptoms of cauda equina are caused by damage to nerve fibers from compression of the nerve roots. Causes of cauda equina syndrome include:

• Disc herniation
• Spinal stenosis 
• Traumatic injury, fracture or subluxation
• Primary and metastatic tumors 
• Infections 
• Hemorrhage or emboli
• Congenital anomalies of the spine
• Iatrogenic injury resulting from complications of spinal surgery or spinal anesthesia

Herniated disk is most common cause. Cauda equina syndrome due to traumatic injury is not age specific. Non-traumatic forms occur primarily in adults.

Who gets cauda equina syndrome?

Cauda equina syndrome is rare. Mean age at onset is 41 years of age (24-67 years) but can occur at any age. The incidence of cauda equina syndrome is not affected by gender or race. Males and females are equally affected.

How is it diagnosed?

Cauda equina syndrome is diagnosed by its presentation, group of symptoms, history of onset and/or injury. Definitive diagnosis is made by magnetic resonance imaging.

How is cauda equina syndrome treated?

The only effective treatment of cauda equina is surgery to decompress the affected nerve fibers. It is considered a surgical emergency and the sooner the surgery is performed the better the prognosis for recovery.

What are the complications?

Complications of cauda e equina include:

• Bladder/bowel dysfunction and incontinence
• Erectile dysfunction
• Pressure ulcers
• Osteoporosis
• Chronic pain
• Spasticity/contractures
• Recurrent urinary tract infections
• Bladder calculi

How can it be prevented?

Prevention of lower spinal injury is the only way to prevent the syndrome. Prevention of complications depends upon the early identification of the syndrome and immediate surgery to relieve the compression.

1. Mauffrey C, Randhawa K, Lewis C, Brewster M, Dabke H. Cauda Equina Syndrome: an anatomically driven review. Br J Hosp Med. 2008;69(6):344-7. 
2. Harrop JS, Hunt GE Jr, Vaccaro AR. Conus medullaris and Cauda Equina Syndrome as a result of traumatic injuries: management principles. Neurosurg Focus. 2004;16(6):e4.
3. Dinning TA, Schaeffer HR. Discogenic compression of the cauda equina: a surgical emergency. Aust N Z J Surg. 1993;63(12):927-34.
4. Ma B, Wu H, Jia LS, Yuan W, Shi GD, Shi JG. Cauda Equina Syndrome: a review of clinical progress. Chin Med J 2009;122(10):1214-22.
5. Shaw A, Anwar H, Targett J, Lafferty K. Cauda Equina Syndrome versus saddle embolism. Ann R Coll Surg Engl. 2008;90(6):W6-8.
6. Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP. Cauda Equina Syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine . 2000;25(12):1515-22.
7. Bell DA, Collie D, Statham PF. Cauda Equina Syndrome: what is the correlation between clinical assessment and MRI scanning?. Br J Neurosurg. 2007;21(2):201-3.
8. Olivero WC, Wang H, Hanigan WC, Henderson JP, Tracy PT, Elwood PW, Lister JR, Lyle L. Cauda Equina Syndrome (CES) from lumbar disc herniations. J Spinal Disord Tech. 2009;22(3):202-6.
9. Indrieri RJ. Lumbosacral stenosis and injury of the cauda equina. Vet Clin North Am. 1988;18(3):697-710.
10. O'Laoire SA, Crockard HA, Thomas DG. Prognosis for sphincter recovery after operation for cauda equina compression owing to lumbar disc prolapse. Br Med J (Clin Res). 1981;282(6279):1852-4.
11. Kingwell SP, Curt A, Dvorak MF. Factors affecting neurological outcome in traumatic conus medullaris and cauda equina injuries. Neurosurgical Focus. 2008;25(5):E7.
12. McCarthy MJ, Aylott CE, Grevitt MP, Hegarty J. Cauda Equina Syndrome: factors affecting long-term functional and sphincteric outcome. Spine. 2007;32(2):207-16. 
13. Kothbauer K, Seiler RW. Tethered spinal cord syndrome in aTethered spinal cord syndrome in adults. Nervenarzt. 1997; 68(4):285-91.
14. Fujisawa H, Igarashi S, Koyama T. Acute Cauda Equina Syndrome secondary to lumbar disc herniation mimicking pure conus medullaris syndrome--case report. Neurol Med Chir. 1998;38(7):429-31.
15. Raj D, Coleman N. Cauda Equina Syndrome secondary to lumbar disc herniation. Acta Orthop Belg. 2008;74(4):522-7.
16. Haldeman S, Rubinstein SM. Cauda Equina Syndrome in patients undergoing manipulation of the lumbar spine. Spine. 1992;17(12):1469-73.
17. Hussain SA, Gullan RW, Chitnavis BP. Cauda Equina Syndrome: outcome and implications for management. Br J Neurosurg. 2003;17(2):164-7.