A 55-year-old female presented with worsening low back pain for 3 weeks along with difficulty urinating and intermittent lower extremity numbness. On physical exam, she had mild lumbar tenderness, perineal anesthesia, decreased rectal tone, and intact motor/sensation and reflexes. She is exhibiting signs and symptoms consistent with cauda equina syndrome, which requires immediate neurosurgery consultation and hospital admission for possible urgent surgical decompression and close neurological monitoring including Foley catheterization.

2.  55 yo female presents w/
worsening low back pain for 3
weeks. Pt also reports that she
has had increasing difficulty
urinating and has
intermittent numbness of
both lower extremities
VS: Temp 98, HR 90, BP 110/70 RR
17, O2Sat: 100% RA
PE: WNWD NAD A&OX3 anxious
HEENT: NCAT; ENT: WNL
Back: no cervical or thoracic
midline tenderness; mild lumbar
tenderness to palpation, no stepoffs
Neuro: CN II-XII intact, PERRL
Ext: MAEW, motor/sensations
intact, reflexes wnl, 2+DP bilat.
Perineal anesthesia, decreased
rectal tone
Rest of exam unremarkable, no
signs of trauma in extremities.

4. http://emedicine.medscape.com/article/1263571-overview

5.  Usually due to central disk herniation at L4-5 or






L5-S1
Plain films often normal vs signs of arthritis
MRI required for radiographic diagnosis
Low back pain associated with unusual complaints
(ie. Pain triggered by head turn)
Unilateral or bilateral lower extremity pain, motor
and/or sensory abnormality
Reflex abnormalities: loss or diminution of
reflexes.
Muscle weakness may be present in muscles
supplied by affected roots.
http://www.wheelessonline.com/ortho/cauda_equina_syndrome
http://emedicine.medscape.com/article/791613-clinical#a0217

6.  Bowel and/or bladder dysfunction
 Range from difficulty starting or stopping a stream of
urine to frank incontinence first of urine then of stool.
Urinary incontinence is on the basis of overflow due to
urinary retention.
 Saddle (perineal) anesthesia
 Poor anal sphincter tone
 Babinski sign, hyperactive reflexes or other signs of
upper motor neuron involvement suggest a
diagnosis other than CES, possibly a diagnosis of
spinal cord compression.
http://www.wheelessonline.com/ortho/cauda_equina_syndrome
http://emedicine.medscape.com/article/791613-clinical#a0217

7.  Immediate neurosurgery/spine consult for possible
urgent surgical spinal decompression
 Frequent neurological checks
 Foley catheter
 Hospital admission

8.  Urinary retention is the most common clinical finding
 Surgical emergency

9. 





www.backpain-guide.com
http://www.med-ed.virginia.edu/courses/raD
http://www.wheelessonline.com
www.LearningRadiology.com
http://emedicine.medscape.com
http://www.hawaii.edu/medicine/pediatrics