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Diagnosis of cauda equina syndrome in the emergency department
  1. David Metcalfe1,2,
  2. Ingrid Hoeritzauer3,4,
  3. Michelle Angus5,
  4. Alex Novak2,
  5. Mike Hutton6,
  6. Julie Woodfield3
  1. 1 Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
  2. 2 Emergency Medicine Research in Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3 Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
  4. 4 Department of Clinical Neurosciences, Edinburgh Royal Infirmary, Edinburgh, UK
  5. 5 Complex Spinal Department, Salford Royal NHS Foundation Trust, Salford, UK
  6. 6 Exeter Spinal Surgery Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  1. Correspondence to Dr David Metcalfe, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford OX3 9DU, UK; david.metcalfe{at}


Cauda equina syndrome (CES) is a spinal emergency that can be challenging to identify from among the many patients presenting to EDs with low back and/or radicular leg pain. This article presents a practical guide to the assessment and early management of patients with suspected CES as well as an up-to-date review of the most important studies in this area that should inform clinical practice in the ED.

  • spine
  • spinal
  • diagnosis

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  • Handling editor Ceri Battle

  • Twitter @TraumaDataDoc, @michangus, @AlexTNovak

  • Contributors DM conceived the need for this article and wrote the first draft. DM, IH, MA, AN, MH and JW helped develop the idea and made important critical revisions to the manuscript. All authors approved the final version.

  • Funding DM is supported by an NIHR Advanced Fellowship and the NIHR Oxford Biomedical Research Centre.

  • Competing interests DM and AN are members of the EMJ editorial board. MH is chair of the National Suspected Cauda Equina Syndrome Pathway.

  • Provenance and peer review Not commissioned; externally peer reviewed.