Cauda Equina Syndrome (CES) is a rare* but potentially devastating condition caused by compression of the cauda equina nerve roots (L1-S5). It is the only true orthopaedic emergency and will be operated on at any time: weekends/nights. It is aimed to be operated on within 48 hrs of symptoms presentation.

The main symptoms of CES are:   

• back pain 
• unilateral or bilateral leg pain is the most common presenting symptom after back pain
• saddle anaesthesia 
• impotence
• sensorimotor loss in lower extremity
• neurogenic bladder dysfunction 
• disruption of bladder contraction and sensation leads to urinary retention and  eventually to overflow incontinence  
• bowel dysfunction is rare   

Sometimes symptoms are more subtle and if you have any doubt then recommend: full examination of the lower back with lower limb neurological examination (power, sensation and reflexes), and abdominal examination (bladder, urinary retention and anal tone). If any ongoing doubt, please ring and discuss with the on call orthopaedic team at the acute trust to see if they would recommend anything further.  

CES most commonly occurs due to a prolapsed intervertebral disc. The disabling nature of these symptoms causes significant medical and social morbidity and high healthcare and social-care costs.

UHDB
Refer the patient through the usual route to ED.

CRH
Refer directly to the CRH Surgical Assessment Unit on 01246 512940.  
If this number is unavailable, contact the ward on 01246 512881/516852. 

KMH
All spinal emergencies are referred directly to ST3 at NUH 0115 9249924 ext. 66217.

NUH
Preferably refer direct to ST3 our SDEC spinal unit 0115 9249924 ext. 66217.  
If patient has been seen F2F by GP or primary care MSK practitioner, the patient can be referred directly to the unit (bypass ED). There must be an accompanying referral.  
Alternatively contact the on-call spinal fellow via switchboard on 0115 924 9924. 

Stockport
Contact the T&O on-call via the hospital switchboard on 0161 183 1010, this may then result in directing the patient to ED.  
Alternatively, email the trauma nurse with the urgent referral on Snt-tr.fractureclinicreferrals@nhs.net
These referrals will be picked up by the trauma nurse between the hours of 7am and 7pm Mon-Fri, and 7am-2pm Sat-Sun. The trauma nurses will get the spinal team to review these acute referrals and a decision made as to whether the patient needs to go to ED or could be directed to the acute spine clinic. 

Sheffield
Contact the Spinal Surgery/Orthopaedic Registrar/Consultant on call via the hospital switchboard on 0114 271 1900.