Cauda Equina Syndrome: A Narrative Review Exploring the Pathophysiology, Clinical Spectrum, Diagnostic Strategies, and Time-Critical Management

Cauda equina syndrome (CES) is an uncommon but severe neurological condition resulting from compression of the lumbosacral nerve roots, leading to motor, sensory, and autonomic dysfunction. Despite its low incidence, CES carries a high risk of permanent disability and medico-legal consequences due to the narrow therapeutic window for intervention. This narrative review synthesizes current evidence on the anatomical basis, pathophysiology, etiology, clinical presentation, diagnostic pathways, classification systems, and management strategies for CES. Particular emphasis is placed on the prognostic distinction between incomplete CES (CES-I) and CES with urinary retention (CES-R), as well as the ongoing debate surrounding the optimal timing of surgical decompression. Long-term outcomes, rehabilitation principles, and emerging neuroprotective strategies are also discussed. Early recognition, prompt imaging, and urgent decompression remain central to improving neurological recovery and quality of life in affected patients.