• Bin Ma, Hong Wu, Lian-shun Jia, Wen Yuan, Guo-dong Shi, and Jian-gang Shi.
• Division of Orthopedics, Orthopedics Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai, China.
• Chinese Med J Peking. 2009 May 20;122(10):1214-22.

ObjectiveTo review the literature on the clinical progress in cauda equina syndrome (CES), including the epidemic history, pathogenesis, diagnosis, treatment policy and prognosis. Data sources All reports on CES in the literature were searched in PubMed, Ovid, Springer, Elsevier, and the Chinese Biomedical Literature Disk using the key terms "cauda equina syndrome", "diagnosis", "treatment", "prognosis" and "evidence-based medicine". Study selection Original milestone articles and critical reviews written by major pioneer investigators about the cauda equina syndrome were selected.ResultsCES is rare, both atraumatically and traumatically. Males and females are equally affected. The incidence of CES is variable, depending on the etiology of the syndrome. The most common cause of CES is herniation of a lumbar intervertebral disc. CES symptoms may have sudden onset and evolve rapidly or sometimes chronic ally. Each type of CES has different typical signs and symptoms. Low back pain may be the most significant symptoms, accompanied by sciatica, lower extremities weakness, saddle or perianal hypoesthesia, sexual impotence, and sphincter dysfunction. MRI is usually the preferred investigation approach. Patients who have had CES are difficult to return to a normal status.ConclusionsThe diagnosis of CES is primarily based on a careful history inquiry and clinical examination, assisted by elective radiologic investigations. Early diagnosis and early surgical decompression are crucial for a favorable outcome in most CES cases.

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