Cauda Equina Syndrome: Spinal Emergency Red Flags in Pune

Cauda equina syndrome is a rare spinal emergency in which the nerves at the bottom of the spinal canal are squeezed. Go to a hospital emergency department the same day if back pain comes with numbness around the buttocks or between the thighs, a new change in passing urine or stool, or weakness in the legs. Early treatment before symptoms become severe can reduce the risk of permanent disability.

World Spine Day falls on 16 October each year, and the World Federation of Chiropractic, which coordinates it, has named the 2026 campaign “Spine Health for Life”. Most back pain is not dangerous. A very small number of people, though, have a problem that cannot wait, and I would rather you know the signs now than learn them in a crisis. This guide by Dr Nirmal Patil, Orthopaedic & Spine Surgeon at Chetna Hospital explains the warning signs in plain words.

What is cauda equina syndrome?

At the lower end of the spinal cord, a bundle of nerve roots spreads out like a horse’s tail. That is what “cauda equina” means in Latin. These nerves carry messages to the legs, the bladder, the bowel and the skin around the genitals and buttocks. A Royal Free NHS patient leaflet describes the condition as rare but serious, affecting between one and three people in every 100,000. Without prompt treatment, it can lead to lasting loss of bladder or bowel control, sexual dysfunction and weakness or paralysis of the legs.

Why the nerves get squeezed

A Royal Buckinghamshire Hospital page lists a large lumbar disc herniation as the commonest cause. Other causes include severe spinal stenosis, fractures from injury, tumours, spinal infection, bleeding around the spine and complications after surgery. A King’s College Hospital NHS leaflet gives the same picture: the most common cause is a lower back disc bulging into the space where the nerves lie.

What are the red flag symptoms of a spinal emergency?

UK hospital leaflets use similar lists. Back pain, or pain running down one or both legs, is usually the background. Any of the following on top of it is the alarm.

Saddle numbness

Loss of feeling or pins and needles between the inner thighs or genitals, or numbness in or around the back passage and buttocks. Some people first notice that the feeling is different when they wipe after using the toilet.

Bladder changes

Increasing difficulty starting to pass urine, not feeling when the bladder is full or empty, leaking, or suddenly needing pads.

Bowel changes

Not being able to hold stool, leaking without realising, or a loss of feeling while opening the bowels.

Leg weakness or sexual changes

New or worsening weakness in one or both legs, stumbling, or legs giving way. A change in erection or ejaculation, or loss of genital sensation, also counts. The Royal Buckinghamshire page says to call 999 or go to A&E immediately. In Pune, that means the nearest emergency department, or an ambulance on 108.

What should I do if I notice these signs?

Do not wait to see if it settles overnight, and do not book a routine appointment. The Royal Free leaflet says to go to your local emergency department immediately. Ask someone to take you, or call an ambulance. Do not ride a two-wheeler or drive yourself, because numb or weak legs make that unsafe.

• Tell the emergency team early: “I have back pain with numbness or bladder or bowel changes. I am worried about cauda equina syndrome.”
• Expect a quick examination of leg strength, sensation and bladder function, usually followed by an emergency MRI of the lower spine.
• Carry any earlier MRI or X-ray reports and your medicine list.

How is cauda equina syndrome treated?

The Royal Buckinghamshire page says treatment most commonly requires urgent spinal surgery (decompression) to relieve pressure on the nerves and improve the chance of recovery. The scan decides what is needed. Early treatment before symptoms become severe can reduce the risk of permanent disability, according to the Royal Free leaflet, which is why speed matters. Our orthopaedic rehabilitation team supports patients through this phase. Individual outcomes vary.

Is every slipped disc this dangerous?

No. Most back pain and most slipped discs improve without surgery. Our guide to back pain warning signs and our page on when spine surgery is needed explain the difference. The emergency signs above are the exception.

Other situations that need urgent care

Back pain after a fall or road accident, especially with new weakness, also needs urgent assessment. Read about spinal fractures and our orthopaedic emergency care.

What do patients say about spine care with Dr Nirmal Patil?

Excerpts from Google reviews on Dr Nirmal Patil’s profiles:

Read all reviews on Google → Individual results vary.

Spine consultation near you in Wakad and Pimpri-Chinchwad

For emergencies, go to the nearest hospital emergency department. For a planned spine consultation, Dr Nirmal Patil sees patients at Chetna Hospital, first floor, near HP Pump, Sambhaji Nagar Road, near Rotary Club, G Block, MIDC, Chinchwad, Pune 411019, and at Precision Spine Clinic, 4th floor, MI Commercial Building, Unit 401, Vishnu Dev Nagar, Wakad, Pune 411057. Patients come from Wakad, Hinjewadi, Tathawade, Punawale, Pimple Nilakh, Pimple Saudagar, Baner, Balewadi, Ravet, Chinchwad, Pimpri, Akurdi, Nigdi, Thergaon, Kalewadi and across Pimpri-Chinchwad. Bring your MRI and X-ray reports to the first visit.

Frequently asked questions

What is cauda equina syndrome in simple words?

Cauda equina syndrome is a rare, serious condition in which the bundle of nerves at the lower end of the spinal canal is squeezed. These nerves control the legs, the bladder, the bowel and sensation around the genitals and buttocks. Because it can cause lasting damage, it is treated as an emergency.

Is back pain with numbness in the buttocks an emergency?

It can be. Back pain together with numbness or pins and needles between the thighs, around the buttocks or back passage, new bladder or bowel changes, or weakness in the legs needs same-day assessment at a hospital emergency department. Do not wait for an appointment, and do not drive yourself.

Can a slipped disc cause cauda equina syndrome?

Yes. NHS patient information from King’s College Hospital describes a disc bulging into the space occupied by these nerves as the most common cause. Most slipped discs never do this and improve with treatment. The warning signs matter because the rare serious case looks different from ordinary sciatica.

Will I definitely need surgery for cauda equina syndrome?

Treatment depends on the scan and your examination. Royal Buckinghamshire Hospital information says the most common treatment is urgent decompression surgery to relieve pressure on the nerves. An emergency MRI decides this, so the first step is reaching a hospital quickly rather than waiting at home.

Where should I go in Wakad or Pimpri-Chinchwad if I have these symptoms?

Go to the nearest hospital emergency department, or call 108 for an ambulance. Once you are stable, Dr Nirmal Patil sees spine patients at Chetna Hospital in Chinchwad and at his Wakad clinic. Call or WhatsApp 91687 46986 for follow-up consultation.

Sources

• Royal Free London NHS Foundation Trust. Cauda equina syndrome (patient information leaflet).
• King’s College Hospital NHS Foundation Trust (2024). Cauda equina syndrome: patient information.
• Royal Buckinghamshire Hospital. Cauda equina syndrome.
• World Federation of Chiropractic. World Spine Day.

This article is general health information and does not replace medical assessment. If you have the symptoms described here, go to an emergency department now.