What immediate management steps should be taken for a patient suspected of having cauda equina syndrome before referral to secondary care?

Immediate management steps for a patient suspected of having cauda equina syndrome before referral to secondary care include:

• Recognise cauda equina syndrome as a neurological emergency requiring urgent assessment and referral.
• Perform a focused clinical assessment to identify symptoms such as bladder or bowel dysfunction, saddle anaesthesia, lower limb weakness, and sensory loss.
• Avoid any delay in referral; arrange immediate urgent referral to secondary care (usually neurosurgery or spinal specialist services) for MRI imaging and further management.
• Do not attempt to provide neuroprotective medications such as methylprednisolone, as these are not recommended in acute spinal cord or cauda equina injury.
• Provide adequate pain relief using appropriate analgesics, such as intravenous morphine if needed, while maintaining spinal precautions.
• Ensure the patient is kept immobile with spinal precautions to prevent further neurological damage during transfer.
• Communicate clearly and honestly with the patient and carers about the urgency and nature of the condition, avoiding speculation about prognosis.

These steps prioritise rapid recognition, immobilisation, pain control, and urgent referral to specialist care to prevent permanent neurological damage ¹,².