Cauda Equina in Pregnancy: Early Management and Outcome

Cauda equina syndrome (CES) is a rare but serious clinical presentation characterised by compression of the lumbosacral nerve roots below the conus medullaris, resulting in lower back pain, bilateral sciatica, motor and sensory deficits, and bladder or bowel dysfunction. Its occurrence in pregnancy is exceptionally rare and poses significant diagnostic and management challenges. We present the case of a 34-year-old woman at 22 weeks' gestation following in vitro fertilization (IVF) who developed acute bilateral leg pain, lower limb weakness, and urinary retention following a three-day history of backache. Neurological examination revealed reduced lower limb power, saddle anaesthesia, and loss of perianal sensation with absent ankle reflexes. MRI demonstrated a large L5/S1 disc extrusion completely filling the spinal canal. Following multidisciplinary assessment, she underwent urgent surgical decompression via left L5/S1 laminotomy within eight hours of symptom onset. A large sequestrated disc fragment was removed, and the nerve root canal decompressed. Post-operatively, the patient reported immediate relief of radicular pain and gradual return of bladder function and motor strength. Her pregnancy continued without complication, and she delivered a healthy baby by elective caesarean section at 38 weeks. At four-month follow-up, she had made a full recovery with complete resolution of neurological symptoms apart from mild residual back pain. This case highlights the importance of prompt recognition and early intervention in CES during pregnancy. A multidisciplinary approach is essential to facilitate timely imaging and surgery while ensuring maternal and fetal safety.