Cauda equina syndrome (CES) is a rare condition that occurs most frequently as a result of a large central lumbar disc herniation, prolapse or sequestration. It is a serious medical emergency that requires prompt diagnosis and treatment by a suitably experienced surgeon. On presentation, around 50-70% of patients with CES have urinary retention (CES-R), while 30-50% have an incomplete syndrome (CES-I). To start with, patients present with motor weakness and sensory deficit. The latter group, especially if the history is less than a few days, usually requires emergency MRI to confirm the diagnosis followed by prompt decompression. It is crucial to avoid CES-I progressing to CES-R while under medical supervision, either before or after admission to hospital, as CES-R has a worse prognosis. The degree of urgency of early surgery in CES-R is still unclear, but it is widely accepted that the earliest possible decompression is essential to remove the mechanical and perhaps chemical factors causing progressive neurological damage. Before surgery, it is essential to provide the patient with a full explanation of the procedure and obtain informed consent. This is important in reducing the likelihood of misunderstanding and litigation in the event of a persistent neurological deficit. Overall, CES is a rare but serious medical emergency that requires prompt diagnosis and treatment by a suitably experienced surgeon. Early surgery is crucial to prevent progressive neurological damage, and a full explanation and consent procedure prior to surgery is essential to reduce the likelihood of misunderstanding and litigation.

Keywords : Cauda equina syndrome, Central disc prolapse, Bilateral sciatica, Urinary retention, Perinealhypoaesthesia Sexual dysfunction.