Which pain and deficits of nerve roots suggest cauda equina syndrome (CES)?

Updated: Jun 14, 2018
  • Author: Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Answer

Pain and deficits associated with nerve root involvement are shown in Table 2, below.

Table 2. Pain and Deficits Associated with Specific Nerve Roots (Open Table in a new window)

Nerve Root

Pain

Sensory Deficit

Motor Deficit

Reflex Deficit

L2

Anterior medial thigh

Upper thigh

Slight quadriceps weakness; hip flexion; thigh adduction

Slightly diminished suprapatellar

L3

Anterior lateral thigh

Lower thigh

Quadriceps weakness; knee extension; thigh adduction

Patellar or suprapatellar

L4

Posterolateral thigh, anterior tibia

Medial leg

Knee and foot extension

Patellar

L5

Dorsum of foot

Dorsum of foot

Dorsiflexion of foot and toes

Hamstrings

S1-2

Lateral foot

Lateral foot

Plantar flexion of foot and toes

Achilles

S3-5

Perineum

Saddle

Sphincters

Bulbocavernosus; anal

Table 3. Root and Peripheral Nerve Innervation of the Lumbosacral Plexus (Open Table in a new window)

Muscle

Nerve

Root

Iliopsoas

Femoral

L2, 3, 4

Adductor longus

Obturator

L2, 3, 4

Gracilis

Obturator

L2, 3, 4

Quadriceps femoris

Femoral

L2, 3, 4

Anterior tibial

Deep peroneal

L4, 5

Extensor hallucis longus

Deep peroneal

L4, 5

Extensor digitorum longus

Deep peroneal

L4,5

Extensor digitorum brevis

Deep peroneal

L4, 5, S1

Peroneus longus

Superficial peroneal

L5, S1

Internal hamstrings

Sciatic

L4, 5, S1

External hamstrings

Sciatic

L5, S1

Gluteus medius

Superior gluteal

L4, 5, S1

Gluteus maximus

Inferior gluteal

L5, S1, 2

Posterior tibial

Tibial

L5, S1

Flexor digitorum longus

Tibial

L5, S1

Abductor hallucis brevis

Tibial (medial plantar)

L5, S1, 2

Abductor digiti quinti pedis

Tibial (lateral plantar)

S1, 2

Gastrocnemius lateral

Tibial

L5, S1, 2

Gastrocnemius medial

Tibial

S1, 2

Soleus

Tibial

S1, 2


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