Cauda equina syndrome: symptoms, causes and red flags

Yes. Cauda Equina Syndrome is considered a medical emergency. (NHS)

Immediate treatment is critical to prevent permanent damage. If pressure on the nerves is not relieved quickly, it can result in lifelong complications such as loss of bladder or bowel control, sexual dysfunction, and paralysis.

Urgent surgical intervention is often required. Any delay in diagnosis or treatment significantly increases the risk of long-term harm.

Recognising the symptoms early is essential. These are often referred to as red flag symptoms.

Key symptoms include:

• Severe lower back pain
• Numbness or tingling around the genitals or anus (saddle numbness)
• Loss of bladder or bowel control
• Difficulty starting or stopping urination
• Leg weakness or difficulty walking
• Sexual dysfunction

If you experience any of these symptoms, you should seek emergency medical attention immediately.

(NHS)

Cauda Equina Syndrome is caused by compression of the cauda equina, a bundle of nerves at the base of the spinal cord. These nerves control movement and sensation in the lower body, including the legs, bladder, and bowels.

If left untreated, the condition can cause permanent nerve damage and serious complications.

There are two main types:

• Incomplete Cauda Equina Syndrome (CES-I)
  Loss of urgency or sensation in bladder and bowel function
• Complete Cauda Equina Syndrome (CES-R)
  Urinary retention and/or bowel incontinence

Cauda Equina Syndrome is usually caused by compression of the spinal nerves (AANS)

Herniated discs

The most common cause, where a disc presses on the nerves

Spinal stenosis

Narrowing of the spinal canal

Trauma or injury

Accidents or falls causing damage to the spine

Tumours and infections

Growths or infections placing pressure on the nerves

Surgical complications

Issues arising after spinal procedures

(Cleveland Clinic)

Whether someone can walk depends on the severity of the condition.

Some people may still be able to walk but experience weakness or numbness. In more severe cases, nerve damage can lead to paralysis, making walking extremely difficult or impossible.

Cauda Equina Syndrome is rare, affecting around one to three people per 100,000 each year in the UK, according to NHS England. If not treated quickly, Cauda Equina Syndrome can cause life changing complications, including:

• Loss of bladder and bowel function
• Sexual dysfunction
• Chronic pain
• Paralysis

Early diagnosis and treatment can significantly reduce these risks (NHS)

Diagnosis usually involves:

• Reviewing symptoms and medical history
• Physical examination
• Urgent imaging, particularly an MRI scan

An MRI scan is the most effective way to confirm nerve compression and should be carried out as quickly as possible. (Cedars Sinai)

Treatment typically involves emergency surgery to relieve pressure on the nerves.

This is often a lumbar decompression procedure, such as a laminectomy. Acting quickly is essential to improve outcomes and reduce the risk of permanent damage.

Post-surgical care may include:

• Pain management
• Physiotherapy
• Support with bladder function

(NHS)

Clinical guidance highlights symptoms that require immediate action, including:

• Severe or worsening neurological symptoms in the legs
• Difficulty urinating or loss of bladder sensation
• Loss of bowel control or rectal sensation
• Saddle numbness
• Reduced anal tone

Patients presenting with these symptoms should be urgently referred for hospital assessment. (National Institute for Clinical Excellence (NICE) and the Medical Protection Society (MPS)

If the warning signs of cauda equina syndrome are missed, or there are avoidable delays in diagnosis or treatment, it can lead to permanent nerve damage and life-changing complications. Where these failures cause additional harm, you may be entitled to compensation.

Our specialist medical negligence solicitors can help you understand whether you have a claim and explain your options. Find out more about cauda equina compensation claims and how we can help.