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Could My Herniated Disc Lead to Cauda Equina Syndrome (CES)?

In your teens, back pain was nothing more than a myth. In your 20s and 30s, your back only hurt after a day of heavy yard work. By the time you hit your late 40s, back pain takes little more than a squishy hotel mattress to have you reaching for the Advil.

As we get older, the tissues in our spine can deteriorate, creating damage, inflammation, and in some cases, causing herniated discs to appear. If you have one, you will do virtually anything to make sure the herniated disc doesn’t worsen. Cauda equina syndrome (CES) is one possible outcome for worsening herniated discs, although CES can be caused by several other issues and most herniated discs do not result in CES.

Causes of cauda equina syndrome

CES is caused by constricted nerves in the spine. Causes of this pressure can include:

  • Bony spurs
  • Tumors
  • Hematomas
  • Herniated discs
  • Spinal stenosis (often age-related)
  • Anything that applies undue pressure to the nerve

What are the symptoms of cauda equina syndrome?

We spoke with Jonathan Landsman, MD, an orthopedic spine surgeon with Banner Brain & Spine, to better understand the symptoms of and treatments for CES. “When pressure constricts nerves in the spine, the clock begins ticking very quickly and symptoms can appear suddenly,” explained Dr. Landsman. Although slow development of symptoms is possible, it is very rare. In almost every case, the symptoms listed below will begin to appear and worsen suddenly or over just a few days. Quick action is the key to a better recovery. Common symptoms include:

  • Partial or full numbness in lower extremities
  • Weakness that could cause an inability to sit up from a chair
  • Severe low back pain
  • Sudden sexual dysfunction
  • Fast-developing bladder and/or bowel control issues, such as difficulty voiding the bladder or bowel or an inability to stop the overflow of urine.


If you experience any of these alarming symptoms, you won’t want to wait long. The symptoms are serious and long-term damage can occur quickly. Dr. Landsman explained that pressure must be released as soon as possible in order to facilitate recovery. For this reason, surgery is the only option for patients with cauda equina syndrome.

“Surgery will typically take place within 48 hours of the diagnosis,” said Dr. Landsman, illustrating the urgency of treating this medical emergency. “Without the surgery, permanent damage can be done to the nerve and to your lower extremities.” Surgery removes the cause of the pressure, whether it’s a tumor, herniated disc or any other cause listed above. If treated quickly, full recovery is possible, although permanent damage may have already taken place. Following the surgery, if further treatment is needed to resolve the root cause of the nerve pressure, a plan will be made with your doctor.

I have a herniated disc. Should I be worried about cauda equina syndrome?

The symptoms of CES are severe, so it’s natural to be concerned. But Dr. Landsman assured us that CES is a rare outcome. Even if you suffer from back pain or have been diagnosed with a herniated disc, chances are you will avoid the complication of CES. Although your risk is low, the possibility of outcomes like CES should serve as motivation to maintain a healthy, flexible spine.

Most herniated discs can be treated non-surgically through physical therapy or passive therapies like massage. Over-the-counter medications, muscle relaxers or anti-inflammatory medications may also be prescribed. If these approaches don’t resolve the issue, treatments like surgery can be recommended. All these outcomes are preferred over the symptoms and possible long-term effects of CES. If you are suffering from back pain or have a herniated disc, work with your physician to resolve it right away.

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