Journal List > J Korean Soc Spine Surg > v.20(4) > 1076005

J Korean Soc Spine Surg. 2013 Dec;20(4):204-209. Korean.
Published online December 31, 2013.
© Copyright 2013 Korean Society of Spine Surgery
Causes and Clinical Manifestations of Cauda Equina Syndrome
Chang Ju Hwang, M.D., Yung Tae Kim, M.D., Dong-Ho Lee, M.D., Choon Sung Lee, M.D., Jung Ki Ha, M.D. and Tae Kyoon Lee, M.D.
Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

Corresponding author: Chang Ju Hwang, M.D. Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, Korea. TEL: 82-2-3010-3530, FAX: 82-2-488-7877, Email:
Received August 06, 2013; Revised September 30, 2013; Accepted November 27, 2013.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Study Design

A literature review.


To describe the causes and clinical characteristics of cauda equina syndrome.

Summary of Literature Review

The cauda equina syndrome, complex symptoms and signs expressed as variable clinical manifestation, has rare incidence but needs attention since it can bring about serious complications and sequales if neglected.

Materials and Methods

The Author reviewed articles reporting the causes and clinical manifestation of cauda equina syndrome.


There are marked inconsistencies in the current evidence base surrounding the definition due to various clinical presentation of cauda equina syndrome.


As there is no symptom or sign which has an absolute diagnostic value in establishing the diagnosis of cauda equina syndrome, any patient in whom a clinical suspicion of cauda equina syndrome arises must undergo urgent magnetic resonance imaging for diagnosis.

Keywords: Cauda equina injury; Cauda equina syndrome; Cause; Definition; Clinical manifestation


Fig. 1
Anatomy of the lower lumbar and sacral spine showing the cauda equina.
Click for larger image

Fig. 2
T2-weighted sagittal (A) and axial (B) MR image of 54 years old female patient with bladder dysfuction, motor weakness and sensory deficit of left leg, it shows a case of cauda equina injury by relapsed lumbar disc herniation after open discectomy.
Click for larger image


Table 1
Predictor value in diagnosing cauda equina syndrome by MRI
Click for larger image

1. Mixter WJ, Barr JS. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 1934;211:210–215.
2. Fraser S, Roberts L, Murphy E. Cauda equine syndrome: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil 2009;90:1964–1968.
3. Mooney V. Differential Diagnosis of Low Back Disorders: Principles of classification. In: Frymore JW, editor. The adult spine. New York: Raven Press; 1991. pp. 1559-1560.
4. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain. JAMA 1992;268:760–765.
5. Kostuik JP, Harrington I, Alexander D, Rand W, Evans D. Cauda equine syndrome and lumbar disc herniation. J Bone Joint Surg Am 1986;68:386–391.
6. Shapiro S. Cauda equina syndrome secondary to lumbar disc herniation. Neurosurgery 1993;32:743–747.
7. Patel NM, Curtis RN, Weiner BK. Aortic dissection presenting as an acute cauda equine syndrome. J Bone Joint Surg Am 2002;84:1430–1432.
8. Mohit AA, Fisher DJ, Matthews DC, Hoffer E, Avellino AM. Inferior vena cava thrombosis causing acute cauda equine syndrome. J Neurosurg 2006;104:46–49.
9. Ahn NU, Ahn UM, Nallamshetty L, Springer BD, Buchowski JM, Funches L, et al. Cauda equina syndrome in ankylosing spondylitis (the CES-AS syndrome): meta-analysis of outcomes after medical and surgical treatments. J Spinal Disord 2001;14:427–433.
10. Sant SM, O'Connell D. Cauda equina syndrome in ankylosing spondylitis: a case report and review of the literature. Clin Rheumatol 1995;14:224–226.
11. Ea HK, Lioté F, Lot G, Bardin T. Cauda equina syndrome in ankylosing spondylitis: successful treatment with lumboperitoneal shunting. Spine (Phila Pa 1976) 2010;35:E1423–E1429.
12. Morandi X, Riffaud L, Chabert E, Brassier G. Acute nontraumatic spinal subdural hematomas in three patients. Spine (Phila Pa 1976) 2001;26:E547–E551.
13. Kou J, Fischgrund J, Biddinger A, Herkowitz H. Risk factors for spinal epidural hematoma after spinal surgery. Spine (Phila Pa 1976) 2002;27:1670–1673.
14. Podnar S, Trsinar B, Vodusek DB. Bladder Dysfunction in Patients With Cauda Equina Lesions. Neurourol Urodyn 2006;25:23–31.
15. Frenckner B, Ihre T. Influence of autonomic nerves on the internal and sphincter in man. Gut 1976;17:306–312.
16. Bruninga K, Camilleri M. Colonic motility and tone after spinal cord and cauda equina injury. Am J Gastroenterol 1997;92:891–894.
17. Giuliano FA, Rampin O, Benoit G, Jardin A. Neural control of penile erection. Urol Clin North Am 1995;22:747–766.
18. Podnar S, Oblak C, Vodusek DB. Sexual function in men with cauda equina lesions: a clinical and electromyographic study. J Neurol Neurosurg Psychiatry 2002;73:715–720.
19. Della-Giustina D. Emergency department evaluation and treatment of back pain. Emerg Med Clin North Am 1999;17:877–893.
20. Todd NV. For debate - guidelines for the management of suspected cauda equine syndrome. Br J Neurosurg 2010;24:387–390.
21. Kennedy JG, Soffe KE, McGrath A, Stephens MM, Walsh MG, McManus F. Predictors of outcome in cauda equine syndrome. Eur Spine J 1999;8:317–322.
22. Ma B, Wu H, Jia LS, Yuan W, Shi GD, Shi JG. Cauda equina syndrome: a review of clinical progress. Chin Med J 2009;122:1214–1222.
23. Bell DA, Collie D, Statham PF. Cauda equina syndrome: what is the correlation between clinical assessment and MRI scanning. Br J Neurosurg 2007;21:201–203.
24. Balasubramanian K, Kalsi P, Greenough CG, Kuskoor Seetharam MP. Reliability of clinical assessment in diagnosing cauda equina syndrome. Br J Neurosurg 2010;24:383–386.
25. Domen PM, Hofman PA, van Santbrink H, Weber WE. Predictive value of clinical characteristics in patients with suspected cauda equi na syndrome. Eur J Neurol 2009;16:416–419.
26. 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 (Phila Pa 1976) 2000;25:1515–1522.
27. McCarthy MJ, Aylott CE, Grevitt MP, Hegarty J. Cauda equina syndrome: factors affecting long-term functional and sphincteric outcome. Spine (Phila Pa 1976) 2007;32:207–216.
28. Yang JY, Lee JK, Song HS, Joo YB, Cha SM. Clinical outcome based cauda equina syndrome scoring system for prediction of prognosis. J Korean Soc Spine Surg 2011;18:57–63.
29. Gleave JR, Macfarlane R. Cauda equina syndrome: what is the relationship between timing of surgery and outcome? Br J Neurosurg 2002;16:325–328.
30. Gitelman A, Hishmeh S, Morelli BN, et al. Cauda equina syndrome: a comprehensive review. Am J Orthop (Belle Mead NJ) 2008;37:556–562.