The cauda equina (Latin for “horse’s tail”) is made up of many nerves that travel down and exit out the sides of the lumbar spine and sacrum (tail bone) and transfer information (motor and sensory) to and from our legs and brain.

If the cauda equina becomes compressed, the resulting cauda equina syndrome (CES) is characterized by symptoms such as severe low back pain (LBP); numbness and weakness in the legs, buttocks, and perineum (pelvic floor region); weakness of bowel and/or bladder control causing incontinence; and sexual dysfunction.

Potential causes for CES include a severe herniated disk in the lumbar spine (most common cause); narrowing of the spinal canal (called spinal stenosis); a lesion or tumor that applies pressure on the cauda equina; an infection, fracture, or trauma (such as a car crash); or a birth defect.

Cauda equina syndrome is typically diagnosed in the following ways: 1) the patient’s history—often of acute LBP with radiating leg symptoms; 2) a neurological exam to assess sensation, strength, gait, and reflexes; and 3) advanced imaging, such as an MRI or CT scan, of the lower back.

If CES has a fast onset, the patient should seek emergency care. Surgery may be required to avoid permanent sexual dysfunction, loss of bowel and/or bladder control, and in some cases, paralysis of the legs.

If the onset of CES is gradual, then a non-surgical approach such as chiropractic care may be appropriate. Doctors of chiropractic are trained to identify and diagnose CES, but chiropractors usually see these patients long after the initial symptoms since most patients go directly to the ER due to their severity. However, a team of healthcare providers comprising of chiropractors, primary care physicians, physical therapists, occupational therapists, social workers, and/or mental health counselors can manage LBP and other residual problems associated with CES. As with all conditions that result in permanent impairment, those afflicted often need to manage symptoms to obtain an optimum quality of life that chiropractic care can greatly facilitate.