Exams and Tests

The initial diagnosis of cauda equina syndrome is made based on findings from the individual's history, symptoms, and physical exam. The physical exam includes testing muscle strength of the lower extremities, evaluating sensation to touch and pain, especially around the groin (perineum), checking the lower extremity reflexes, and evaluating rectal tone, sensation, and reflex.

Imaging studies helpful in the diagnosis include plain x-ray films of the lower back to assess for evidence of trauma or severe arthritis (degenerative changes). MRI with and without contrast provides a detailed look at tumors, infection, intervertebral disks, and nerve roots. This study allows the doctor to determine if the nerves are being compressed, to what degree, and by what structures. Findings from these studies help the surgeon plan the appropriate treatment.

Not all people with back pain and/or leg pain and changes in bowel or bladder function have cauda equina syndrome. More common causes of bladder changes are urinary tract infections, which can be identified by a simple urine test, and diabetes, which can be identified with blood tests.

People with symptoms suggesting a possible infection or tumor should be further evaluated with blood and other tests to identify any abnormalities.