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Cauda equina syndrome (CES) is a rare but devastating complication, which warrants an urgent or emergency decompressive surgery. To diagnose it early and also, a timely intervention can halt neurological sequelae. More common causes for CES include chronic disc diseases, spinal injury, and fractures. However, there are less common causes such as spinal manipulation, tuberculosis, and spinal tumors. Here, we report a rare cause of CES precipitated by extreme manipulation of the spine during total hip replacement surgery done under neuraxial blockade. This condition was diagnosed by the acute pain service team at an early stage and successfully treated with emergency decompressive surgery to avert any further neurological complications.