STUDY DESIGN: This is a retrospective study. OBJECTIVES: We made a scoring system using the symptoms of cauda equina syndrome(CES) and we studied the efficacy of the scoring system. SUMMARY OF THE LITERATURE REVIEW: There has been no definite scoring system with clear factors that can predict the clinical results of cauda equine syndrome. MATERIALS AND METHODS: Between 1998 and 2006, 21 patients who were diagnosed with CES and who were followed for more than 2 years were enrolled in this study. There were 6 cases of HIVD, 6 cases of degenerative spondylosis, 7 cases of vertebral fracture and 2 cases of metastatic spinal tumor. We made a scoring system for CES (SSCES) using 8 symptoms among the general clinical manifestations that accompany CES, which are low back pain, sciatic neuropathy, sensory and motor disorder of the lower extremities, loss of a saddle sensation, voiding difficulty, disorder of the anal sphincter tone and deep tendon reflex disorder. RESULTS: The last clinical outcomes were 3 excellent patients, 5 good patients, 5 fair patients and 8 poor patients. The mean preoperative SSCES was 11.7+/-2.8(7-16) and the mean final follow up score was 7.6+/-3.4(2-13). Eight cases that had a mean preoperative SSCES score of 6 or below showed good clinical results with a mean SSCES of 3.9+/-11(2-5) on the final follow up, and 13 cases with a mean preoperative SSCES score of 7 or above showed bad clinical results with a mean SSCES of 9.9+/-1.9(7-13) on the final follow up. CONCLUSIONS: The prognosis was better on the final follow up for the patients with a lowere preoperative SSCES. So, for the treatment of CES, preoperative evaluation using the SSCES is thought to be very useful for predicting the prognosis.