Cauda Equina Syndrome: A Review of Classification, Diagnosis, Treatment, and Best Practices

Background: Cauda equina syndrome (CES) is a rare but life-altering disease resulting from compression of the nerve roots at the spinal cord's terminus. CES typically presents with low back pain, sciatica, sensorimotor deficits, and bowel and bladder dysfunction. Owing to its rarity, the condition is often missed, leading to significant morbidity and potential legal implications for physicians. Methods: This review synthesizes the current literature on CES, including its epidemiology, pathophysiology, classifications, and management strategies. Emphasis is placed on the diagnosis and treatment of CES as well as the legal implications of CES for spine surgeons. Results: The literature reveals variability in the reported prevalence of CES, with incidence rates ranging from 0.34 to 7 per 100,000 individuals annually. The timing of decompression remains debated. Some studies report no significant difference in outcomes between decompression within 24 hours vs. 48 hours, while others emphasize the importance of immediate intervention. Legal cases related to CES frequently involve delayed diagnosis, with significant ramifications for physicians. Conclusions: Surgical decompression remains the definitive treatment of CES, though the timing of surgery requires careful consideration to balance the urgency of intervention with the risks of complications. Further research is needed to explore strategies that would allow for improvement in identifying and treating patients with CES in a timely manner. Level of Evidence: Level V . See Instructions for Authors for a complete description of levels of evidence.