The combination of saddle anesthesia, back pain with radicular symptoms, and bladder dysfunction is most consistent with which syndrome?

• A. Cauda equina syndrome
• B. Brown-Séquard syndrome
• C. Anterior cord syndrome
• D. Central cord syndrome

Answer: (A)

The main concept is that this pattern points to compression of the cauda equina, a bundle of lumbosacral nerve roots below the spinal cord. Saddle anesthesia indicates involvement of the sacral roots (S2–S5) that supply the perineal area, and back pain with radicular symptoms reflects irritation or compression of individual nerve roots. Bladder dysfunction occurs because the sacral parasympathetic and somatic nerves controlling the detrusor muscle and urinary sphincter are affected. Together, these features define cauda equina syndrome, a neurologic emergency requiring urgent evaluation and decompression if possible.

Other spinal syndromes involve the spinal cord itself and have distinct patterns. Brown-Séquard is a hemicord lesion that causes ipsilateral motor weakness and vibration/proprioception loss with contralateral loss of pain and temperature below the level of the lesion. Anterior cord syndrome disrupts the corticospinal and spinothalamic tracts with bilateral motor and pain/temperature loss but preserved vibration and proprioception. Central cord syndrome typically presents with greater weakness in the upper limbs and has a cape-like distribution of sensory loss over the shoulders and arms, with relatively preserved sacral function. The saddle area findings and bladder involvement, in contrast, point specifically to cauda equina syndrome.