Cauda Equina Syndrome-A 2025 Narrative Review
Andreas Conte1, Rishabh Jain1, Aranghan Lingham2
1Department of Trauma and Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, SE1 9RT London, UK.
Summary
Cauda Equina Syndrome (CES) is a surgical emergency requiring prompt diagnosis and treatment to prevent permanent disability. This review updates management guidelines, emphasizing standardized red flag symptoms and aiming for 24-hour MRI diagnostics.
Area of Science:
- Neurology
- Neurosurgery
- Emergency Medicine
Background:
- Cauda Equina Syndrome (CES) is a critical condition resulting from lumbosacral nerve root compression.
- Delayed diagnosis and treatment of CES can lead to severe, irreversible neurological deficits.
Purpose of the Study:
- To provide a 2025 update on the diagnosis and management of CES, incorporating the latest UK guidelines.
- To outline a management pathway for suspected CES in district general hospitals without 24-hour MRI facilities.
Main Methods:
- This narrative review synthesizes current literature and the UK's 2025 Getting It Right First Time (GIRFT) pathway.
- Analysis of key changes in diagnostic criteria, imaging protocols, and treatment timelines for CES.
Main Results:
- Updated guidelines standardize red flag symptoms and emphasize bladder scans as a rule-in investigation.
- The review advocates for 24-hour MRI capabilities and urgent surgical decompression (within 24 hours) for confirmed CES.
- A proposed pathway addresses management in hospitals lacking 24-hour MRI.
Conclusions:
- Implementing standardized protocols and timely interventions is crucial for improving outcomes in CES patients.
- The updated guidelines aim to reduce diagnostic delays and ensure appropriate surgical management for CES.
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