Cauda equina syndrome: What you need to know to be aware of the spinal emergency which lists back pain, numbness and bladder issues among its symptoms

Many people may not have heard of it, but cauda equina syndrome (CES) is an incredibly serious condition – affecting approximately 8,000 people in England every year.   

Cauda Equina Awareness Day is held on 1 October each year and is a timely reminder of not only why there needs to be more awareness of the condition, but also what health professionals need to consider when making a diagnosis.

Being aware of CES could make all the difference in whether you or a loved one make a full recovery or are left with life-long disabilities.

What is cauda equina syndrome?

CES is a serious but rare condition that occurs when the nerves at the bottom of the spinal cord are compressed.

These nerves supply the muscles that control the bladder, bowel and legs as well as the skin from the groin and buttocks, down to and including, the feet.

What are the signs and symptoms?

Patients can present with a variety of symptoms which are often referred to as “red flags". These can include:

• Lower back pain
• Sciatica
• Weakness/numbness/pain down one or both legs
• Loss of feeling between the legs
• Bladder and bowel issues
• Numbness or tingling around the bottom and sexual organs
• Sexual dysfunction

The need for urgent medical treatment

Cauda equina syndrome is a medical emergency and the best outcomes are achieved where patients are treated within 24 hours of symptoms starting. 

If the diagnosis isn't suspected – or the patient is misdiagnosed – then the condition will progress and permanent neurological damage will occur. Patients are left with life-changing symptoms including incontinence or paralysis of the lower limbs.

Treatment for the condition is surgical decompression to relieve pressure on the spinal cord.

What are my legal rights following misdiagnosis or treatment delay?

As a medical negligence solicitor I’ve acted for numerous clients who have presented to their GP or hospital with symptoms consistent with CES. Indeed, during the period 2013-2016 data shows that more than 20% of spinal compensation claims in England related to cauda equina.

I’ve seen first hand what the devastating effects of untreated or late-treated cauda equina are. My clients have suffered very sudden and dramatic changes in continence, mobility and sensation. These are often permanent and can lead to longer term psychological symptoms and relationship breakdowns.

If you believe that you or a loved one haven’t received appropriate treatment or there have been delays and it’s caused an injury, then you're able to speak to specialist solicitors like me and my team who can advise on what the most appropriate way forward is and whether a there is a legal claim for damages.

Providing answers and rehabilitation

A legal claim can not only provide answers but also access to specialist rehabilitation and therapies to try and live with the effects of cauda equina.

However, there's also more to the legal process. We understand the need to support those affected by cauda equina with issues relating to employment, and benefits as well as family issues.

Cauda Equina Syndrome Interactive Pathway

One of the real challenges for doctors is assessing whether a patient has severe back pain alone or whether the spinal cord is compressed. Cauda equina syndrome presents in different ways and the combination of symptoms can be vastly different from patient to patient. 

There’s no test to confirm the diagnosis and this is usually made from assessment of the clinical signs and symptoms as well as MRI scan images.  

Even once the diagnosis is made there can be complexities surrounding the timing of onset of symptoms and whether surgery will in fact be beneficial.

The NHS England Getting It Right First Time (GIRFT) team published a report on spinal services in 2019 which highlighted that some patients with suspected cauda equina weren't being referred for onward care and treatment.

Since then GIRFT has collaborated with a wide variety of healthcare professionals to create a treatment pathway to help clinicians in primary and secondary care manage these complex patients, reducing delay and improving outcomes.  

The pathway is supported with detailed guidance to highlight good practice for emergency referrals and investigations.

It focuses on patients where there is pain due to lumbar disc prolapse as this is the most common scenario. Management is suggested based upon whether symptoms are recent and/ or progressive in nature.

In particular, the detailed guidance relating to referrals and safety net advice are helpful in ensuring that appropriate information is conveyed to professionals and patients.

What clinicians still need to consider

However, there are limitations to the pathway and some patients will continue to go undiagnosed or be diagnosed late. The pathway assumes that the clinician will correctly identify symptoms of cauda equina. However, these can vary and in some cases are initially quite subtle.

In other cases the onset or progression of injury is very rapid. While the guidance refers to other causes of CES (e.g. tumour, bleeding or infection), these are less prominent and therefore clinicians will need a high index of suspicion to invoke the pathway. The pathway also assumes that resources will be available to diagnose and treat the condition.

In summary, the pathway is a helpful development in the management of this condition and will hopefully improve outcomes for a large number of affected patients.

However, it’s still vital that people are aware of the signs of cauda equina as there will, however, be a number of patients who will be managed based on a wrongful diagnosis or less urgently than the condition warrants.

Find out more about Irwin Mitchell's expertise in supporting people access specialist rehabilitation and therapies following a CES diagnosis at our dedicated cauda equina claims section.