Spine

Cauda equina syndrome

Mechanism

Compression of the nerve root bundle below the end of the spinal cord, usually from a large midline disc herniation. All roots from L2 downward may fail at once.

Recognition

The KNGF guideline lists as features of a neurological emergency: urinary retention, urinary or faecal incontinence, severe motor loss and widespread neurological symptoms. Saddle anaesthesia belongs to these.

Course

An emergency: the longer the compression lasts, the smaller the chance of full recovery of bladder and bowel function. Doubt alone is reason enough to refer the same day.

What the guideline recommends

The guideline gives no treatment here but a course of action: with features of a neurological emergency, immediate referral follows. Physiotherapy has no place before the cause is removed.

Structures

• Sciatic nerve

Joints involved

• Intervertebral disc (symphysis intervertebralis)

Clinical tests

• Straight leg raise

Sources

• Swart NM, Apeldoorn AT, Conijn D, Meerhoff GA, Ostelo RWJG (red.). KNGF-richtlijn Lage rugpijn en lumbosacraal radiculair syndroom. Koninklijk Nederlands Genootschap voor Fysiotherapie / VvOCM. Amersfoort. 2021 https://www.kngf.nl/kennisplatform