Cauda equina syndrome.
Cauda equina syndrome is rare, but when it does occur it can lead to poor outcomes with significant legal implications. Controversy exists as to whether the timing of surgical intervention may affect these outcomes. Recent studies have reinforced that early surgical decompression may be beneficial to early return of function. Expeditious surgery is, however, only one factor that can affect outcome in this syndrome. The cauda equina consists of peripheral nerves, both motor and sensory, below the level of the conus medullaris and within the spinal canal. The conus medullaris contains the myelomeres of the five sacral nerve roots. Damage to any part of this structure may result in the cauda equina syndrome (CES). The clinical symptoms of CES are manifest by low back pain, sciatica, saddle and perineal hypoesthesia or anesthesia, a decrease in anal tone, absent ankle, knee, or bulbocavernous reflexes, and bowel and bladder dysfunction. The literature continues to be conflicting and controversial with regard to timing of surgical decompression. Judicious physical examination and prompt diagnosis remain the cornerstones of effective management of this syndrome.