Cauda Equina Syndrome - recognize this as a surgical emergency.

Cauda equina is the syndrome produced by hemisection of the spinal cord.

Common causes are disc herniation following lifting heavy objects, trauma causing vertebral fracture like MVAs (motor vehicle accidents) or post surgical infection after surgery on the spine causing compression or a hematoma in that situation.

Patient loses power in legs, loses control over urine and bowel. There is numbness in the peri-anal area.

Diagnosis is made by a distinct level of neuro deficit below the lesion on the contra-lateral side. At the level of the lesion, there is hyperaesthesia. So a spinal hemisection involving T10 would have numbness below the umbilicus on the contralateral side and a hyperesthesia at the level of the umbilicus on the ipsilatral side.

One important finding is decreased pain/sensation in the presence of worsening motor function - this means that as the weakness progresses, the sensory nerve roots that were initially being pressed and causing neurogenic pain - these will now be severed and pain  will disappear.