Cauda equina syndrome (CES) is characterized by low back pain, sciatica, lower limb motor weakness and sensory deficits, saddle anaesthesia, bowel and bladder dysfunction and occasionally paraplegia. The syndrome is classified according to onset: rapid or slow. Rapid onset CES, because of its characteristic presentation is easily recognized. The slow, chronic progression and varying presenting signs and symptoms of slow onset CES often mimic mechanical low back pain and makes the diagnosis difficult in its early stages. The case of a 23-year-old female with slow onset cauda equina is presented to illustrate this. A discussion of lumbar spine anatomy as it relates to the clinical presentation of cauda equina syndrome and the influence of associated degenerative factors follows. The most common presenting signs and symptoms are reviewed with special emphasis on those which can help diagnose CES in its early stages. Patients prognosis following surgical decompression is highlighted.
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