What Causes Cauda Equina Syndrome? 

Cauda equina syndrome (CES) is a serious and  life-changing condition that can have a hugely negative impact on a person’s quality of life. It is therefore important to understand the causes of this condition, and the warning signs, to ensure that cases of CES are caught and treated early.

If you experience any of the red flags of cauda equina syndrome, it is important you seek medical attention as soon as possible. Unfortunately, some doctors do not ask about some of the less well-known symptoms, so it is important to give them as much detail as possible and ask for a second opinion if they appear to dismiss you. 

A failure to diagnose and treat CES early enough can lead to loss of bowel and bladder function, chronic pain or a loss of feeling in your lower body, leg weakness and loss of sexual function.

In this guide, JMW Solicitors will explain the causes of cauda equina syndrome, how to spot the red flags early, and the long-term consequences of delayed treatment, as well as explore how medical negligence can contribute to cauda equina syndrome.

What are the common causes of cauda equina syndrome?

This condition affects the cauda equina, a group of nerve roots at the bottom of the spinal cord. These nerves are responsible for the function of our bowels, bladder, sexual organs and lower limbs; as such, it can lead to serious health problems if these nerve roots are compressed.

Because cauda equina syndrome is caused by pressure or damage to the cauda equina nerve roots, any preexisting conditions that involve compression of the spinal canal are considered to be the most important risk factors for CES.

Cauda equina syndrome can be caused by any of the following:

• A herniated disc (or slipped disc) in the lower back, causing a disc to be pushed into the spinal canal
• Narrowing of the spinal canal (also known as lumbar spinal stenosis)
• A tumour near the spinal canal
• A spinal infection, haemorrhage or fracture
• Complications from a severe lumbar spine injury, e.g. caused by a fall or car crash
• A congenital abnormality of the spine or birth defect
• Mistakes made during spinal surgery

General lifestyle-related risk factors for cauda equina syndrome are less clear. It can affect anyone of any age, but people who are overweight, or involved in work that puts strain on their spine, may be at greater risk.

What are the symptoms and warning signs of cauda equina syndrome? 

If you are experiencing symptoms of cauda equina syndrome, this should be treated as a medical emergency. Any of the following could be red flags that show you may have cauda equina syndrome:

• Numbness, weakness, or a burning/prickling sensation in your legs, bum, hips or inner thighs
• Loss of sexual function
• Bladder and bowel dysfunction, including urinary and/or faecal incontinence
• Not being able to pass urine, or altered flow/sensation when you do
• Not getting the urge to pass urine/have a bowel movement 

Another possible sign of cauda equina syndrome is the onset of sciatic pain in both legs. You will be able to identify this as a pain that starts at the lower back and travels down into the buttocks and legs, sometimes all the way down to the ankle.

The only way to confirm cauda equina is by having an MRI scan, and it is important that a GP or hospital doctor refers you on an emergency basis. If a diagnosis is made following the scan, surgery is required within 24-48 hours to give the patient the best chance of making a full recovery. 

What are the long-term effects of cauda equina syndrome? 

Symptoms vary among people affected by cauda equina syndrome, which means that each person’s experience with CES will be different. However, if the condition is left untreated, it can lead to a number of long-term health problems, with the potential to completely change and devastate an individual’s life.

Long-term effects include:

• Ongoing problems with bladder and bowel function, or a total loss of bladder and bowel control
• Chronic pain that can get worse over time
• Permanent loss of sexual function 
• Leg weakness causing mobility problems

Many people with cauda equina syndrome have to change their daily routines due to the physical effects making it too difficult for them to work or complete everyday tasks without support and assistance. Those affected by CES can also go through serious emotional and psychological problems, meaning they lose confidence or experience issues with intimacy and social anxiety due to the difficulties associated with managing the condition.

Can cauda equina syndrome be caused by medical negligence?

If a person is experiencing early signs of cauda equina syndrome, prompt diagnosis and surgical treatment can lead to much better outcomes, with milder symptoms and an improved long-term prognosis. However, if your doctor, nurse or surgeon has provided substandard treatment or acted negligently, they can end up making the condition worse.

There are a number of ways in which a medical practitioner's clinical negligence can cause or contribute to cauda equina syndrome, including:

• Failing to recognise the signs or symptoms of cauda equina syndrome during a physical examination, meaning the diagnosis is delayed and the patient is unable to receive early surgery. This increases the chances of the syndrome worsening and becoming permanent.
• Delays in receiving the necessary MRI scans, with patients sometimes waiting for days or even weeks before they undergo a scan, during which time their condition deteriorates to the extent that permanent nerve damage can no longer be prevented.
• Mistakes made during surgery on the spinal cord mean that a patient's condition is worsened or left untreated, which can result in irreversible damage.
• Surgical errors that damage the cauda equina nerves can also cause a patient who did not have any CES signs before to develop the condition. 

If you have experienced delays or below-standard treatment for CES, and it was the result of negligence by a GP, hospital doctor, nurse or physiotherapist, you may be entitled to medical negligence compensation.