Cauda equina syndrome is a rare presentation of lumbar spine disease that can result in significant lower limb neurological deficits and permanent bladder, bowel and sexual dysfunction. Delays in diagnosis and treatment can result in irreversible worsening of the condition. Therefore, this is a major cause of litigation against spinal surgeons in the NHS. Urgent MRI scanning is the diagnostic gold-standard and should be available at all hours in all hospitals where patients with potential cauda equina syndrome present. Imaging should be performed within 4 hours of requesting and if the scan is positive for cauda equina compression then treatment should be undertaken as a matter of urgency. Surgery to decompress the cauda equina can prevent further deterioration in symptoms but compared to elective lumbar surgery carries a much higher rate of complications owing to the nature of the disease. Despite rapid treatment, patients can suffer from significant long-term sequelae and require prolonged periods of rehabilitation.