Cauda equina syndrome-a practical guide to definition and classification

Abstract

Purpose: International uniformity of definition and classification are crucial for diagnosis and management of cauda equina syndrome (CES). They are also useful for clinicians when discussing CES with patients and relatives, and for medicolegal purposes.

Methods: We reviewed published literature using PubMed on definition and classification of cauda equina syndrome since 2000 (21 years). Using the search terms 'cauda equina' and 'definition' or 'classification', we found and reviewed 212 papers.

Results: There were 17 different definitions of CES used in the literature. There were three well-defined methods of classification of CES. The two-stage system of incomplete CES (CESI) versus CES with retention (CESR) is the most commonly used classification, and has prognostic value although the details of this continue to be debated.

Conclusion: We used the existing literature to propose a clear definition of CES. We also drew on peer-reviewed published literature that has helped to amplify and expand the CESI/CESR dichotomy, adding categories that are both less severe than CESI, and more severe than CESR, and we propose clear definitions in a table form to assist current and future discussion and management of CES.

Keywords: Cauda equina syndrome; Classification; Definition; Disc herniation.

Fig. 1

MRI scan example of a disc herniation causing cauda equina compression. The sagittal image on the left shows a large posterior disc herniation at L5/S1 level, and the axial scan on the right at the L5/S1 level shows that the disc herniation fills almost the entire spinal canal, and compresses the cauda equina