Cauda equina syndrome from lumbar disc herniation.

The syndrome can progress to paraplegia with rectal and urinary incontinence and represents a surgical emergency.1 Sixty percent of patients are male with a mean age of 42 years, and 82% have a history of chronic low-back pain. In two-thirds of patients, the syndrome is associated with trauma or injury.2 However, cauda equina syndrome should be considered in patients whose chronic back pain has rapidly escalated regardless of a history of trauma or injury (Figure 1).1 Figure 1: Mid-sagittal T2-weighted magnetic resonance imaging (MRI) showing massive prolapse of the L4–L5 disc, causing cauda equina syndrome. Although most presentations (70%) are acute, a more gradual onset can also occur3