Syndrome B probable surgical emergency

Very rare

Saddle anaesthesia (around anus, scrotum or vagina) Distal anaesthesia Evidence of UMN or LMN lesion

Loss of sphincter control or urinary retention Weakness of legs peripherally


Spinal cord (UMN) or cauda equina (LMN) compression

Large disc protrusion, paralysing nerve root

Syndrome C

Syndrome D

Anaesthesia or paraesthesia of the leg Foot drop Motor weakness Absence of reflexes


Distal pain with or without paraesthesia Radicular pain (sciatica) Positive dural stretch tests

Very common

Lumbar pain (unilateral, central or bilateral) ± buttock and posterior thigh pain

Posterolateral disc protrusion on nerve root or disc disruption

Disc disruption or facet dysfunction

Fortunately, syndromes A and B are extremely rare but, if encountered, urgent referral to a surgeon is mandatory. Clinical features of the cauda equina syndrome are presented in Figure 33.8 . Syndrome B can follow a bleed in patients taking anticoagulant therapy or be caused by a disc sequestration after inappropriate spinal manipulation.

Fig. 33.8 Cauda equina syndrome due to massive prolapsed intervertebral disc

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