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Cauda Equina Syndrome

Daniel Morris, Kyan J. Berger
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  • Description
  • Risk Factors
  • Etiology


  • Signs and Symptoms
  • Essential Workup
  • Tests
  • Differential Diagnosis


  • Pre-hospital
  • Initial Stabilization
  • ED Treatment
  • Medication (Drugs)
  • In-patient Considerations
The following is an excerpt....

Compression of lumbar and sacral nerve fibers in cauda equina region:

  • Nerve fibers below conus medullaris
  • Fibers end at L1–L2 interspace.
Risk Factors
  • Neoplasm
  • IV drug use
  • Immunocompromised state
  • Herniated disc most common:
    • L4–L5 discs > L5–S1 > L3–L4
    • Most common in 4th and 5th decades of life
  • Mass effect from:
    • Myeloma, lymphoma, sarcoma, meningioma, neurofibroma, hematoma
    • Spine metastases (breast, lung, prostate, thyroid, renal)
    • Epidural abscess (especially in IV drug users)
  • Blunt trauma
  • Penetrating trauma
  • Spinal anesthesia

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See Also
Images >
1 2
FIGURE 8-12. Cauda equina compression from L5 fracture. A: Sagittal FSE intermediate-weighted images. There is diminished height of the L5 vertebral body both anteriorly and posteriorly. Disc material from L4-5 has herniated into the centrum of the L5 vertebral body with interruption of the superior endplate of L5 (curved arrow). A fracture fragment is rotated into the prevertebral space (white arrow). The posterior cortex is retropulsed into the anterior epidural space (black arrows). A small epidural hematoma is incidentally noted (asterisk). B: Axial FSE intermediate-weighted at the L5 level shows the retropulsed bone fragments compressing the thecal sac. Disc material has herniated through the endplate (open arrow).Credit: From Flanders AE, Croul SE. Spinal trauma. In: Atlas SW. Magnetic Resonance Imaging of the Brain and Spine. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2002:1776–1777, with permission.