Cauda equina syndrome: Recognising ‘red flags’ for back pain in primary care

Cauda equina syndrome is a rare, but potentially devastating condition caused by compression of the lumbosacral nerve roots, usually due to a massive disc herniation. Missed or delayed diagnosis leads to lower limb paralysis with bowel, bladder and sexual dysfunction. The aims of the article are to describe the pathophysiology, epidemiology, typical presentation, diagnostic features and red flag symptoms, presented in line with the RCGP curriculum topic guide. We have included guidance for GPs undertaking clinical assessments, including telephone appointments. This article also includes referral pathways to specialist services, long-term follow-up and community support services for these patients.