The need for paramedics to be able to identify cauda equina syndrome

Cauda equina syndrome (CES) is a rare neurological emergency that both authors have seen within the last 3 years of clinical practice, and both feel, from their own experiences of paramedic education, is not currently covered sufficiently.

This article will look at CES in two parts. Firstly, it will establish what is meant by CES, how it can be suspected at pre-hospital examination, and what actions should be taken when a clinician suspects CES. It will then look at medico-legal issues of CES as well as considering the consequences of a delayed diagnosis.

The spinal cord descends from the base of the medulla oblongata in the vertebral space, terminating approximately two thirds of the way down the vertebral column at the level of the second lumbar vertebra, although this can vary from between the twelfth thoracic vertebrae and the third lumbar vertebrae (Coggrave, 2011). From this point of termination, known as the ‘conus medullaris’ (Tortora and Derrickson, 2011), the nerve roots, which will go on to become the lumbar sacral and coccygeal nerves, descend downwards through the vertebral column before exiting at the respective vertebrae. As the nerves descend form the conus medullaris they fan out inside the vertebral column to create the appearance of a horses tail, known as the corda equina (Coggrave, 2011) (Figure 1).