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Acute onset low back pain leading to a diagnosis of cauda equina syndrome: a case study

02 February 2022
14 min read
Volume 33 · Issue 2

Abstract

Cauda equina syndrome is rarely seen in primary care, but advanced practitioners must be aware of the possibility. Haley Read and Gerri Mortimore highlight a case study leading to a diagnosis of the condition

One of the most common symptoms managed in primary care is lower back pain, which affects approximately 20% of the UK population at any one time (National Collaborating Centre for Primary Care, 2009). There are many differential diagnoses for the cause of back pain, with one such potential diagnosis being cauda equina syndrome. In this instance, it is of paramount importance that the correct diagnosis is reached quickly with urgent referral into secondary care for the instigation of treatment to prevent paralysis. This case review will examine a patient presenting to primary care with lower back pain and diagnosed with cauda equina syndrome.

The incidence of patients presenting to their primary care practice with new onset lower back pain (LBP) is around 20% of the UK population at any one time (National Collaborating Centre for Primary Care, 2009). It is cited among the most common symptoms managed in primary care (Greenwood and Shipley, 2017), with a myriad of potential diagnoses (Innes et al, 2018). With the relatively new addition in extended roles of the primary care advanced nurse practitioner (ANP), it is paramount that they are able to safely assess, examine, diagnose, and mange this generic symptom effectively.

One less common, albeit time-critical, condition to consider with LBP is cauda equina syndrome (CES) (Long et al, 2020). Much of the literature indicates the complexity yet urgency of the diagnosis, instigating the need for a robust clinical history and examination to be performed. Emphasis has been placed on ensuring risk stratification and red flag criteria be addressed (National Institute for Health and Care Excellence (NICE), 2021).

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