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Cauda equina syndrome

Lower back pain is a condition that affects millions of people across the UK. For some people, it can be treated or at least managed. But, for others, the impact of lower back pain can be much more serious. 

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In 2014, it was estimated to be responsible for 11% of total disability of the UK’s population. Cauda equina syndrome (CES) is a rare, yet severe, disorder in the lower back. And the consequences can be life-changing for you and those closest to you. 

Read on to find out about cauda equina syndrome and how it is treated – as well as the options available if you or a loved one are now coping with cauda equina syndrome and its impact.


What is cauda equina syndrome (CES)?

Your spinal cord runs from the brain to the lower back – with nerves branching off it at different levels to send signals to and from different parts of the body. It is not unusual for wear and tear to cause the discs between your vertebrae to move and put pressure on the spine. This can also squeeze the nerve roots as they come out from the spinal column.  

When this happens, it can put pressure on the sciatic nerve – affecting pain and sensation in the legs. In rare cases, the disc can slip out – or prolapse – in a central position and presses against the nerve roots that affect sensation to the saddle area (the buttocks and between the legs) and bowel, bladder and sexual function, as well as the legs. 

This central prolapse is called cauda equina syndrome as it affects a collection of nerve roots at the end of your spinal cord that is said to resemble a horse’s tail – or ‘cauda equina’ in Latin.


Cauda equina syndrome case study

Alicia was a successful self-employed conference organiser and ran her own photography business in Birmingham. Following a period of minor back problems, she awoke one morning to find that she had developed severe back pain. She was taken to Cheltenham Hospital where a prolapsed disc was suspected. However, she was discharged later that day without an MRI scan having been undertaken.

Alicia's Story

Cauda equina syndrome experts

Our skilled team of specialist lawyers want to speak to you today for free.
Nick Tubb

Nick Tubb


Medical negligence

Nick has successfully pursued complex medical negligence brain and spinal injury claims for clients, securing a number of multi-million pound awards. Tell Nick your unique story.

Andrea Rusbridge

Andrea Rusbridge


Medical Negligence

Andrea has 30+ years’ experience as a lawyer. She successfully helps families who have endured pain, suffering and financial losses.

Natasha Read

Natasha Read

Principal Associate

Medical Negligence

Natasha has a varied caseload including serious injury claims against NHS trusts, private hospitals/practitioners and General Practitioners.

Frequently Asked Questions

  • What are the different sizes of nerve fibres in the cauda equina

    Nerve fibres that come down and out from the spinal column are different sizes:

    • Motor fibres supply the muscles, with relatively large ones supplying the legs
    • Sensory fibres that carry touch and joint position are medium in size
    • Fibres that carry pain sensation to the legs and supply the sphincters and bladder are the smallest

    The size of the fibres is important because it determines how much pressure they can withstand. It also affects how long it would take until their blood supply is cut off and they die. The smaller nerve fibres are much more vulnerable to any pressure – even for a short period.

    Whether the nerve fibre can recover following compression depends on if the interruption to the blood supply is in front of or behind the cell body. Cell bodies to the sensory nerves and nerves for the sphincters and bladder are further down the body. As such, they are less likely to be able to recover after they are compressed.

  • What are the causes of cauda equina syndrome ?

    CES is often caused by a prolapsed or slipped disc, which ‘slips’ out of position and puts pressure on the nerves in the lower spine. It can simply be the result of old age as your spine continues to be put under the normal stresses and strains of everyday life.

    Trauma and medical negligence are also potential causes of cauda equina syndrome. This means there can be times when the cause is preventable and is the fault of someone else. If this is your experience, it could also mean that you have a claim for cauda equina syndrome compensation.

    When you experience such a life-changing injury, it can be hard to know where to turn to next – especially when you are not at fault. Our cauda equina syndrome solicitors have the knowledge to help in such cases, however 0370 086 8687 or send us a message to find out how. 

  • How common is cauda equina syndrome?

    Fortunately, CES is rare and it is estimated that there are fewer than three cases per 100,000 people. Data for 2010-11 reveals that 981 surgical decompressions for CES were carried out in England that year, which means there were just 1.9 cases per 100,000.

    Of course, no matter how rare a condition might be – it is no consolation to those living with the severe effects of CES.

  • Cauda equina syndrome symptoms, signs and diagnosis

    According to the Cauda Equina Syndrome UK Charity, there are several ‘red flag’ cauda equina syndrome symptoms to look out for. These can include a loss of:

    • Feeling in the ‘saddle’ area (between the legs)
    • Bladder or bowel control, function or sensation
    • Sexual function
    • Feeling or sensation in your legs

    It is vital to diagnose cauda equina syndrome quickly. But this can be delayed as bladder, bowel or sexual problems can have a wide range of causes. To be sure that CES is the cause, however, it often calls for an urgent MRI scan.

    If your diagnosis (and treatment) of CES is delayed, it can have a serious and perhaps even life-changing impact. It is so vital to treat CES quickly. This is highlighted by research from the NHS, which shows that the delay or failure of diagnosis or treatment accounted for nearly two-thirds of CES compensation claims between 2014 and 2016. At Shoosmiths, we are here to help if this happens to you – call our friendly team on 0370 086 8687 or send us a message to see if you might have a claim.

  • How is cauda equina syndrome treated

    The first stage is called incomplete cauda equina syndrome (CESI). If this occurs, it is likely you will still experience some bladder control and some sensation – though both are reduced. At this stage, there is often severe pain in your lower back and one or both legs. Numbness in the anal and genital area is also common with CESI.

    CESI must be treated as a surgical emergency before it becomes complete CES, which is known as CESR. The ‘R’ here stands for ‘retention’ (of urine). With CESR, there is no bladder sensation – and this leads to incontinence. The smaller nerve fibres that control bladder, bowel and sexual function are usually permanently damaged. And this makes recovery highly unlikely.

    The most effective form of cauda equina syndrome treatment is lumbar decompression surgery. As it is vital to relieve pressure on the spinal cord, CES treatment will typically involve either:

    • The removal of a section of bone from one of your vertebrae (laminectomy)
    • The removal of a section of damaged disc (discectomy)
  • Cauda equina syndrome recovery

    In the short-term, it is common for the surgical wound to feel sore. But everyone is unique – so the speed and extent of your cauda equina syndrome recovery will be different to someone else.

    If you receive the correct urgent treatment, cauda equina syndrome symptoms can improve with time. Nerves can take a long time to recover. But, if your surgery is successful, it is possible that you may regain bladder and bowel function in 18 months to two years – or sometimes longer.

    Surgery cannot always repair things if the nerves are permanently damaged, however. Even with treatment, it is possible you may never fully recover function in the affected areas. And it means that you will need to learn to adapt to the life-long and lasting changes in your body. 

  • How can cauda equina syndrome affect someone?

    For anyone who is learning to cope with chronic cauda equina syndrome, it is often the case that practical, physical, and emotional support proves so essential – to you and your family. The loss of bladder or bowel function, for example, can have a major impact on a person’s work or social life. Severe pain or paralysis of the legs can also be long-term consequences of CES.

    In addition to the obvious physical impact of CES, there will be an associated – and often unseen – emotional impact. Feelings such as anxiety and depression can make it even more challenging to adapt to changes in your body. It can also affect relationships with loved ones. The emotional impact can feel especially raw if it is the result of a preventable accident or medical negligence.

  • How much cauda equina syndrome compensation could I receive?

    There is no set amount of compensation that you might receive if your case is a success. Every case is decided on its own merits and the amount will be based on your unique needs.

    At Shoosmiths, our team has experience of obtaining substantial awards for people with cauda equina syndrome. Read how one of our clinical negligence experts, Nicholas Tubb, helped after delayed CES diagnosis had a serious and life-changing effect on an individual from Birmingham.


What should I do next?

Are you suffering from the impact of CES? Think you might have a claim? Unsure who to turn to for help? At Shoosmiths, we are determined to help those who need us. You can take advantage of our substantial experience and knowledge – and all it takes is one phone call or email.

For a free consultation, call us on 0370 086 8687 or send us a message now.

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