There is a spinal nerve bundle from the lumbar to the caudal level, like a horse’s tail, hence the name cauda equina. Cauda equina damage is more common clinically, mostly due to absolute or relative stenosis of the lumbar spinal canal due to various congenital or acquired causes, which compresses the cauda equina and produces a series of neurological dysfunctions. Treatment The best treatment for cauda equina syndrome (CES) is surgery. The principle is early diagnosis, early surgery and, if necessary, emergency surgery. The aim of surgery is to release the compression and release the adhesions. Surgery: 1. Laminectomy and decompression: The purpose is to enlarge the spinal canal to achieve decompression. It is indicated for fracture or fracture dislocation. The scope of decompression is sufficient to completely remove the compressive material at the site of compression or to center on the dislocated segment, with no more than one vertebral segment above and below the lamina. 2, anterior decompression or internal fixation: mainly used for the removal of the anterior compression from the spinal cord, with direct decompression, and can be given different methods of internal fixation to enhance stability, and can also apply artificial vertebral body to replace the fractured or damaged vertebral body to restore the original height. 3, cauda equina anastomosis: (1) proximal cauda equina anastomosis, the 1st and 2nd lumbar segment cauda equina nerve has not been dispersed, so the nerve root aggregation, injury cauda equina arrangement disorder, can clarify the site of injury, after diagnosis to brain cotton wrapped around the incision, to protect the surrounding tissue, saline repeatedly flush to remove blood and blood clots. (2) distal cauda equina anastomosis, according to the anatomical characteristics of the cauda equina, the motor nerve of the cauda equina below L3 gradually leans to the ventral side, while the sensory nerve is distributed dorsally. In order to preserve the function of the lower limb, the motor nerve, i.e. the anterior root, should be anastomosed as much as possible. The cauda equina nerve has no peripheral nerve membrane, but has peripheral nerve bundle membrane, so there is some difficulty in suturing. 4. Cauda equina release: It is suitable for patients with chronic injury resulting in CES due to cauda equina adhesions, and the surgery must be performed under microsurgical techniques. The reasons affecting the efficacy of surgery are: (1) the cauda equina nerve and nerve roots are under long-term pressure, and the secondary arachnoiditis occurs without timely decompression, resulting in cauda equina palsy and intractable low back pain, so early surgery should be performed. If early surgery is not possible, cauda equina nerve exploration should be performed during surgery, and cauda equina nerve release should be performed if there are adhesions. (2) Improper choice of surgery destroys the stability of the spine, resulting in medically induced lumbar instability, slippage, and spinal stenosis, so open decompression should be taken as far as possible. (3) Unskilled surgery, rough movements, and unclear anatomical levels further damage the cauda equina. (4) Incomplete removal of the nucleus pulposus of the intervertebral disc or missed diagnosis and misdiagnosis. (5) Lumbar spinal stenosis is a pathological basis leading to CES, and incomplete decompression can lead to surgical failure. Therefore, intraoperative attention should be paid to the enlarged decompression of the central canal and nerve root canal. (6) Contrast can increase the cauda equina injury, and the contrast should be carefully operated and selected when performing contrast. (7) Postoperative re-adhesion and scar tissue compression are important reasons for ineffective surgery or aggravation of symptoms. There are many studies on CES, but its pathogenesis is still not fully understood, and the treatment effect for severe CES is not optimistic. In order to improve the clinical cure rate, further work is needed to: 1. fully apply the development of molecular biology and other basic medical technology to further explore the pathogenesis of CES; 2. improve surgical precision, accurately select the surgical approach, apply microsurgical techniques, accurately locate and adequately decompress the cauda equina nerve to prevent adhesions and postoperative scar tissue from recompressing the cauda equina nerve and reduce re-injury.