What Is Cauda Equina Syndrome?
Cauda equina syndrome (CES) is a rare but serious condition that affects the nerves at the lower end of the spinal cord. Recognising its signs quickly is vital, as it is considered a medical emergency that requires prompt treatment to prevent lasting disability. When diagnosis or treatment is delayed because of medical negligence, the effects of CES can be life-changing.
Because cauda equina syndrome occurs relatively rarely, people may not immediately recognise its symptoms, or understand the long-term health consequences associated with it. Learning more about the condition can therefore be important in making sure people who live with CES get the treatment they need at every stage.
In this guide, we will explain what cauda equina syndrome is, what causes it, and the impact it can have on your health, as well as highlighting the various treatments that are used to help and support those affected.
What Is Cauda Equina Syndrome?
Cauda equina syndrome occurs when the nerves located at the bottom of the spinal cord - known as the cauda equina - become compressed or damaged. The name 'cauda equina' comes from Latin and means 'horse's tail', referring to how these nerves fan out like a horse's tail at the point where the spinal cord finishes, near the lower back.
These nerve roots control sensation and movement in the lower limbs, bowel and bladder function, and the pelvic area. If they become compressed or damaged, this can cause sensory and motor deficits, affecting basic bodily functions and mobility.
Due to the severe nature of nerve compression, CES is classified as a medical emergency. Early treatment reduces the risk of permanent nerve damage, which can result in lasting and serious health issues.
Estimates from the NHS suggest that cauda equina syndrome is rare, occurring in one to three in every 100,000 people in the UK. However, the actual incidence may be higher or lower. You can find out more here about how rare cauda equina syndrome may be.
What Causes Cauda Equina Syndrome?
Cauda equina syndrome occurs when the nerves at the lower end of the spinal column become compressed or damaged. There are several conditions can potentially cause this compression:
- Herniated disc (slipped or ruptured disc): A common cause, where the soft cushioning between spinal bones pushes out, compressing the cauda equina nerve roots.
- Spinal trauma: Injuries from accidents or falls, causing fractures or swelling that puts pressure on the nerves.
- Spinal tumours: Growths in or near the spinal column can apply pressure to the cauda equina nerves.
- Inflammatory conditions: Diseases like arthritis can cause swelling around the nerves.
- Spinal stenosis: Narrowing of the spinal canal, often due to ageing or arthritis, placing pressure on the nerves.
- Infections or epidural abscesses: Although less common, infections and abscesses can lead to inflammation and pressure on the nerves.
- Complications from spinal surgery: Surgical procedures can sometimes inadvertently result in nerve damage or compression, especially when medical errors occur.
Prompt identification of these underlying conditions is critical, as if they lead to cauda equina syndrome, this will require immediate medical attention.
Take a look at our guide to what causes cauda equina syndrome for more information.
What Are the Symptoms of Cauda Equina Syndrome?
Being able to spot the symptoms of cauda equina syndrome quickly can make a huge difference to your long-term health. Symptoms vary from person to person, but there are some common signs you should look out for:
- Severe lower back pain: Especially if this pain suddenly worsens or is unlike pain you've experienced before.
- Numbness or weakness in your legs, feet or lower limbs: This might make it difficult to walk or stand comfortably.
- Bladder problems: Such as difficulty urinating, altered sensation when passing urine, a weak urine stream, or not being able to urinate at all.
- Bowel dysfunction: Including constipation or a sudden loss of bowel control.
- Sexual dysfunction: Changes in sensation or difficulties engaging in sexual activity.
You might also notice unusual sensations around your pelvic area, inner thighs, or buttocks, as these areas are typically affected by CES.
Spotting the red flag symptoms of cauda equina syndrome
Certain symptoms mean you should seek urgent medical help immediately. Doctors call these 'red flag' symptoms because they indicate a medical emergency that requires emergency surgery to prevent permanent paralysis or lasting nerve damage. These include:
- Sudden numbness around your bottom, groin, or inner thighs (known as saddle anaesthesia).
- Sudden and complete loss of bladder and bowel function, or inability to pass urine.
- Rapid onset of severe leg weakness or altered sensation, affecting your ability to walk or stand.
If you experience any of these red flag symptoms, call 999 to attend your nearest emergency department immediately. Early treatment makes a significant difference to your chances of recovery.
You can learn more here about the early symptoms of cauda equina syndrome, or how to spot and act upon cauda equina red flags.
What Are the Long-Term Health Consequences of Cauda Equina Syndrome?
If cauda equina syndrome isn't diagnosed or treated quickly enough, it can lead to long-term or even permanent health consequences. Even with treatment, some people who have CES may still experience ongoing challenges in daily life. The severity varies greatly depending on how quickly the condition was identified and treated.
Possible long-term effects of CES include:
- Chronic pain: Many people who have experienced CES live with ongoing lower back or leg pain, which can affect everyday activities and quality of life.
- Permanent nerve damage: Delays in diagnosis and emergency surgery can cause lasting nerve injury, leading to altered sensation or numbness in the lower limbs, feet, or pelvic area.
- Mobility problems or paralysis: In severe cases, CES can lead to lasting leg weakness or permanent paralysis, which might require support from a physiotherapist or occupational therapist to help regain mobility and independence.
- Bladder and bowel dysfunction: Loss of bowel and bladder control may become permanent, requiring ongoing management and support.
- Sexual dysfunction: Changes in sexual function, sensation or ability can have a lasting impact on emotional wellbeing and personal relationships.
- Mental health challenges: Living with the long-term impacts of CES can affect emotional health, causing issues such as anxiety, depression or reduced confidence.
With appropriate medical care and support - including input from doctors, physiotherapists, occupational therapists and support groups - many people are able to adjust to these long-term changes.
To find out more, read our guide to the long-term effects of cauda equina syndrome, or our features on how CES can impact body image and sexual relationships.
How Is Cauda Equina Syndrome Diagnosed?
Diagnosing cauda equina syndrome quickly is essential to preventing permanent nerve damage. Doctors typically diagnose CES using a combination of tests:
- Magnetic resonance imaging (MRI) scans: An MRI scan is the gold standard for diagnosing CES. It provides high-resolution images of the spinal cord and lumbar spine, allowing doctors to identify any compression of the cauda equina nerve roots. If CES is suspected, an urgent MRI scan is essential to avoid delays in treatment.
- Straight leg raise (SLR) test: This physical examination helps detect nerve root irritation or lumbar disc herniation, both potential causes of CES. During the SLR test, the patient lies down while the doctor slowly raises each leg, keeping the knee straight. Pain radiating down the leg during this test may indicate nerve compression associated with CES.
- Bulbocavernosus reflex test: This test evaluates the reflex involving the muscles controlling bladder function. An absent or diminished reflex can indicate compression of the cauda equina nerve roots, a key indicator of CES.
- Catheter tug test: Used in patients experiencing urinary retention, this test assesses urinary reflexes by gently pulling on the catheter to check for a normal contraction of the external urethral sphincter. An absent reflex may indicate nerve root compression associated with CES.
- Digital rectal examination: This examination assesses the tone and sensation of the rectal muscles. Decreased muscle tone or a loss of sensation can suggest compression of the cauda equina nerve roots, indicative of CES.
Early and accurate diagnosis through these methods is essential to minimise the risk of permanent injury and to ensure timely surgical intervention. Find out more about the most common methods used to diagnose cauda equina syndrome.
How Is Cauda Equina Syndrome Treated?
When cauda equina syndrome is diagnosed, rapid treatment is critical to relieve pressure on the cauda equina nerves and reduce the risk of permanent nerve damage.
The primary treatment for CES is emergency surgery, typically spinal decompression. This procedure aims to relieve pressure on the cauda equina nerves. Doctors usually perform the surgery within 24 to 48 hours of diagnosis to improve the chances of preventing lasting nerve damage. During surgery, the spinal surgeon will remove or correct the issue causing nerve compression, such as a herniated disc, tumour, or epidural abscess.
After this, a combination of medical, physical and psychological therapies may be used, including:
- Physiotherapy: A physiotherapist works closely with patients, creating rehabilitation plans to help rebuild strength in the lower limbs, improve mobility, and regain independence.
- Occupational therapy: An occupational therapist may help individuals adjust to changes in daily living by providing practical support, equipment and strategies for managing life with altered mobility or sensory and motor deficits.
- Pain management: Many patients experience ongoing pain even after surgery. Doctors typically prescribe medications or recommend specialist treatments to help manage chronic pain, improving overall comfort and quality of life.
- Psychological support: CES often affects mental health due to its life-altering consequences. Counselling or psychological therapies can support people who experience anxiety, depression, or emotional distress following CES diagnosis or treatment.
- Bladder and bowel care: Specialists provide ongoing management and practical advice to improve bladder and bowel function and help people regain control and confidence in their daily lives.
While the goal of treatment is a full recovery, outcomes differ between individuals. Many patients find that early diagnosis and immediate surgical intervention lead to better outcomes, reducing the chance of permanent paralysis or other long-term complications.
When Can You Make a Cauda Equina Syndrome Compensation Claim?
If your cauda equina syndrome diagnosis or treatment was delayed due to medical negligence, you may be able to claim compensation. This usually happens when medical professionals - such as GPs, spinal specialists, surgeons, or staff in emergency departments - miss or ignore the signs of CES, delaying essential treatment.
Common scenarios involving medical negligence related to CES include:
- Delayed diagnosis: A GP or hospital doctor fails to recognise CES symptoms or does not urgently refer you for an MRI scan.
- Misdiagnosis: Symptoms are mistakenly diagnosed as less serious conditions, leading to delays in emergency surgery.
- Delayed MRI scans: Medical staff fail to provide an urgent MRI scan to diagnose CES swiftly, despite clear symptoms.
- Delayed surgery: surgery needs to be carried out within 24-48 hours of the onset of symptoms to reduce the likelihood of permanent nerve damage.
- Surgical errors: Mistakes are made during spinal surgery, causing or worsening nerve damage.
Claiming compensation can help you access any specialist care, rehabilitation, and support needed for long-term recovery, and improve your quality of life after CES. You can read more about why compensation claims for cauda equina syndrome are so important.
Find Out More
Living with cauda equina syndrome can feel overwhelming, but there is information and support available to help you adjust to life with CES.
Visit our Cauda Equina Syndrome Hub for more information, including the following resources:
- Living with Cauda Equina Syndrome: A Complete Guide: Comprehensive and compassionate guidance to help you cope practically and emotionally with CES.
- What to Do if Your Loved One is Diagnosed with Cauda Equina Syndrome: Advice on how to support a family member who has been affected by this condition.
- Ask the Expert: Q&A on Cauda Equina Syndrome – Answers to common questions about CES from expert Sue Paddison
To speak with a solicitor about potentially making a cauda equina syndrome claim, call JMW today on 0345 872 6666, or fill in our online enquiry form.
