Cauda Equina Syndrome

The cauda equina are a bundle of nerve roots located at the base of the spinal cord. They send and receive messages to and from your legs, feet and pelvic organs.

Cauda equina syndrome is a rare disorder which occurs when these nerves become compressed. It can develop incredibly quickly and must be treated as a medical emergency. If it is not diagnosed and treated within 24-48 hours the effects can be catastrophic.

It results in a crippling back condition, which causes life-changing and irreversible effects, including: lower back pain, bladder and bowel weakness, sexual dysfunction, weakness of the lower limbs or even paralysis, as well as many other possible symptoms.

Typically, CES occurs much more frequently in adults than children. Some common causes include:

• a slipped, ruptured or herniated disc (the most common cause)
• spinal stenosis – narrowing of the spinal canal
• a spinal lesion or tumour
• a spinal infection, inflammation, haemorrhage or fracture
• a traumatic accident, such as a car crash
• a congenital abnormality or birth defect
• a surgical error.

There are several worrying signs which a medical professional should recognise as ‘red flag symptoms’ of CES. If you are suffering any of the following symptoms, you should seek immediate medical advice and tell the doctor that you suspect it might be cauda equina syndrome:

• pins and needles, pain, numbness or weakness in both legs which causes problems with mobility
• problems with bladder and/or bowel function, such as incontinence or difficulty passing urine
• severe lower back pain
• saddle and/or sensory abnormality
• sexual dysfunction that comes on suddenly
• severe or worsening altered sensation in the legs, buttocks, inner thighs, backs of legs or feet
• poor leg reflexes.

The faster cauda equina syndrome is diagnosed, the greater the likelihood of recovery. It has been widely acknowledged by medical experts that the nerves must be decompressed within 48 hours of the onset of symptoms in order to reduce the extent of the nerve damage and relieve the symptoms.

A doctor will make their diagnosis based on several factors and assessments:

• they will look at your medical history and recent activity
• a physical examination to assess your strength, reflexes, sensation, stability and movement
• blood tests
• an MRI scan to view a 3D image of the spine
• a myelogram (an x-ray of the spine following the injection of a special contrast material which identifies pressure points on the spinal cord)
• a CT scan to take images of the spine from different angles.

As soon as the diagnosis is made, you will need surgery to relieve the pressure on the cauda equina nerves and prevent permanent damage. Depending on the cause of your CES, the surgeon may remove blood, bone fragments or an abnormal bone growth to decompress your spine.

If the syndrome were caused by a tumour, radiotherapy may be an option, especially if surgery is medically impossible.

Surgical errors or delays can result in significant claims and compensation.

Even with treatment, some patients do not fully recover their normal bodily functions. It entirely depends on how much damage was done to the nerves and how quickly it was treated.

It’s important to stress that delayed diagnosis is not always the fault of the medical professional. If the patient themselves sought medical advice too late, then unfortunately their nerves may have already been compressed for too long to be able to recover. 

Yet there are many cases where doctors are at fault for delayed diagnosis or misdiagnosis. Patients are often sent away and told that they are suffering a different back complaint. Or the doctor does not immediately recognise the symptoms as cauda equina syndrome, takes too long investigating, by which point the irreversible damage has already been done.

If diagnosis and treatment do not happen within that critical 48-hour window, the nerve damage can cause lifelong complications, such as paralysis below the waist, loss of bladder and/or bowel control, or loss of sexual function.

There are several reasons why you might be able to claim medical negligence compensation for your cauda equina treatment:

• if you were misdiagnosed because the doctor failed to recognise your ‘red flag’ symptoms
• if your diagnosis was delayed because the doctor did not identify the condition and send you for surgery quickly enough, leading to a worsening of the symptoms
• inadequate or poorly performed surgery which may have compressed the spinal cord even further
• failure to recognise complications following the surgery.

Depending on the circumstances of your case, you could claim: damages for the injury itself and the ongoing suffering and treatment you must endure, the cost of further surgery, the cost of therapies to relieve the symptoms, loss of earnings, the cost of care, and the costs of aids and equipment now required to manage your disability.

As the impact of CES can be so debilitating and can affect you for the rest of your life, it’s important to claim the compensation you need to support you if you can no longer work or now need a paid carer.

Coles Miller partner and Head of the Medical Negligence department, David Simpson , is a specialist in cauda equina syndrome claims. His track record includes successfully securing compensation totalling £825,000 for two CES patients left with permanent disabling symptoms restricting mobility because of failings by two GPs and two NHS trusts.

If you believe you may have a claim for medical negligence due to delayed or misdiagnosed cauda equina syndrome.

Immediate surgery may be required to relieve pressure on the nerves by removing blood, bone fragments or abnormal bone growth.

Radiotherapy is also an option if cauda equina has been caused by a tumour and surgery is medically impossible. 

Surgical errors or delays can result in significant claims and compensation. We have a cauda equina specialist, David Simpson , who is always on hand to support you.