Site of injury: below the L1-L2 disc space.
Muscular - variable, assymmetric loss:
(1) Motor function varies from normal to paresis to flaccid (not spastic) paralysis.
(2) The patient may be mobile.
(3) The patient may experience difficulty in: (1) external rotation and extension of the thigh at the hip; (2) flexion of the knee; (3) weakness of all muscles below the knee.
Sensory - variable, assymmetric sensory loss with a parasympathetic defect:
(1) There may be perineal and saddle sensory loss with loss of erotic genital sensation, or these may be preserved.
(2) Erectile dysfunction may occur in males.
(3) Local pain in the back
(4) Patients may experience referred pain or dysesthesia (pain on a gentle touch of the skin).
(5) Radicular pain may be prominent and helps distinguish the cauda equina syndrome from the conus medullaris syndrome (radicular pain absent).
Urinary bladder - unpredictable, ranging from incontinence to urinary retention:
(1) Bladder function may be retained.
(2) The presence of flaccid bladder limits evacuation with retention.
(3) The inability to control the sphincter can result in urinary incontinence.
Bowel - unpredictable, ranging form incontinence to stool retention:
(1) Bowel function may be retained.
(2) The presence of flaccid musculature may result in the inability to evacuate the bowel.
(3) The inability to control anal sphincter can result in incontinence.
