Cauda Equina Syndrome (CES) is a rare and very serious condition. Regardless of how CES occurs, it is vital that any patient is treated as a surgical emergency.
 
Located within your spine are various nerve roots which are responsible for sending and receiving signals or messages to different parts of your body.
 
The area relevant to CES is just above the waist which is approximately where the spinal cord ends. The group of nerves in this region are called the Cauda Equina.
 
The Cauda Equina are responsible for the supply of nerves to the lower limbs, bladder and bowels. They also supply sensation to the skin around the back passage and bottom (otherwise known as the perineal area).
 
CES occurs when the nerves are compressed which can result in an individual suffering from one or more of the red flag signs and symptoms including bladder and bowel dysfunction, saddle anaesthesia, sexual dysfunction and nerve root problems in the lower limbs.

Here of some of the ways CES can occur:

• Large lower lumbar disc herniation – this is usually compression of the discs at the L4/L5 and L5/S1 area. The NHS describes a herniated disc as being a “slipped disc” which occurs “when a soft cushion of tissue between the bones in your spine pushes out”. This is said to be the most common way CES can occur.

• Congenital – a patient may have a congenitally narrow spinal canal (through problems such as spina bifida) or may have acquired spinal stenosis (narrowing of the spaces within your spine).
• Tumours – such as metastases, lymphomas and spinal tumours.
• Trauma resulting in injuries such as fractures.
• Infection – including circumstances where an abscess may form either within the spinal canal or by pressing on the Cauda Equina.
• Post operative complications such as a haematoma. A haematoma is a solid swelling of clotted blood within the tissues. Such a complication can occur following a spinal anaesthetic.

 
The above is not an exhaustive list.
 
Irrespective of how CES occurs, the red flag signs and symptoms of CES remain the same and urgent medical advice and treatment should be sought from your GP or local A&E department.
 
If you are suffering CES, then your clinician should make an urgent referral for further investigations and treatment. 

If you have attended upon a treating clinician displaying symptoms of CES and were not urgently referred to an appropriate clinician or hospital for investigations and treatment, you may be able to make a medical negligence claim for financial compensation.

Our specialist team can offer advice on a no-obligation basis. After having an initial consultation with you, our team will assess whether you may have a potential medical negligence claim.

If you then decide that you would like to proceed with a claim we have a range of funding options available including a No-Win, No-Fee Agreement supported, if appropriate, by legal expenses insurance.

Do not delay – there can be a time limit affecting your right to claim, so contact us now to see if you have a potential medical negligence case.

The onset of Cauda Equina Syndrome may be sudden, within hours or sometimes gradual over weeks or months. No matter how a patient may develop Cauda Equina Syndrome, it is imperative that it is diagnosed and treated as early as possible. Therefore, it is extremely important that patients are referred urgently to appropriate medical professionals who can confirm a diagnosis of CES and provide urgent treatment – usually surgery.

Some medical professionals distinguish different stages of CES as follows:

CES-S
This means CES suspected or suspicious. A patient may show symptoms such as bilateral radiculopathy which may feel like the nerves have been pinched and can result in pain, weakness, numbness, or difficulty controlling specific muscles, particularly the legs.

CES-I
This means CES incomplete. If the CES is incomplete, a patient will generally have urinary difficulties of neurogenic origin including altered urinary sensation, difficulty urinating which could be a poor flow or perhaps feeling like you want to urinate but cannot and loss of feeling that you need to urinate. There may also be loss of sensation in and around the saddle and genital area. 

CES-R
This means CES retention and generally means that the CES is complete. Usually, a patient will have issues including urinary retention without being aware of such a problem as there can often be no pain associated with the retention and complete loss of control of the bladder. A loss of sensation around the saddle and genital area is usually full or extensive at the very least.

It is vital that patients are urgently referred to a suitable medical professional at the CES-S and at the latest, the CES-I stage. The later a patient waits for a referral and subsequent treatment, the worse a patients outcome and recovery is likely to be.

Patients at the CES-S and CES-I stage should be referred urgently for a MRI scan of the spine as this will help to identify whether a patient has CES and the likely cause.

It is vital that the referral is urgent as patients can deteriorate to CES-R rapidly. 

Can I make a medical negligence claim if I have not been urgently referred?

If you have attended upon a treating clinician displaying symptoms of Cauda Equina Syndrome and were not urgently referred to an appropriate clinician or hospital for investigations and treatment, you may be able to
make a medical negligence claim for financial compensation.

Our specialist team can offer advice on a no-obligation basis. After having an initial consultation with you, our team will assess whether you may have a potential medical negligence claim.

If you then decide that you would like to proceed with a claim we have a range of funding options available including a No-Win, No-Fee Agreement supported, if appropriate, by legal expenses insurance.

Do not delay – contact us now to see if you have a potential medical negligence claim.

Cauda Equina Syndrome is a surgical emergency. Once a patient has been diagnosed with the condition, they should undergo surgery within 48 hours. If Cauda Equina Syndrome is not diagnosed or treated in a timely manner, patients can suffer devastating physical, psychological and financial consequences which may have otherwise been avoided.

If you feel let down by a health care professional, whether this is your GP, a hospital or private surgeon, you should consider taking legal advice regarding a medical negligence claim.

It is important to understand that you will have to speak about the substandard treatment you received and your resulting injuries and disabilities which you may find traumatic and upsetting. However, your case will be confidently handled by our team of solicitors who are sympathetic and knowledgeable about your situation.

It is important to understand that the only legal remedy available is compensation. We cannot discipline a healthcare professional, force a hospital or individual healthcare professional to change how they work or make a healthcare professional or organisation say sorry to you.

If you are an adult with mental capacity to bring a legal claim, you must do so within 3 years from when the alleged medical negligence occurred or when you first realised that you’d suffered injury.

In the case of young people aged under 18, the 3 year limit does not start to run until their 18th birthday. Put simply, they have until their 21st birthday to bring a legal claim. Normally, a parent or other person close to them can make a claim on their behalf until they attain the age of 18 when the person may want to continue the claim them self.

If the claim is for an individual who cannot manage their own affairs because of a mental disability, the strict 3 year time limit may not apply.  A spouse, parent or other person close to them can make a claim on their behalf but should do so as soon as possible on their behalf.
 
It is best to take legal advice as soon as possible as Cauda Equina Syndrome is a serious condition and a medical negligence claim may take sometime to investigate.

If you are concerned that you do not have the funds to pursue a medical negligence claim do not worry.

Our specialist team can offer advice on a no-obligation basis. After having an initial consultation with you, our team will assess whether you may have a potential medical negligence claim.

If you then decide that you would like to proceed with a claim we have a range of funding options available including a No-Win, No-Fee Agreement supported, if appropriate, by legal expenses insurance.

Do not delay – contact us now to see if you have a potential medical negligence claim.

Colin unfortunately suffered from Cauda Equina Syndrome on two occasions.

Colin woke early one morning with debilitating back and leg pain. Colin recognised the severity of the pain as being associated with Cauda Equina Syndrome, as he had been treated for the condition ten years before.
 
Colin had recovered from his previous Cauda Equina Syndrome although he had been left with some bladder symptoms. Colin therefore knew how important it was to obtain a quick diagnosis and undergo emergency surgery.
 
Colin attended his local Accident and Emergency department and informed staff that he was suffering with Cauda Equina Syndrome. 
 
Colin knew that he needed an MRI scan and surgery within 48 hours from the onset of his symptoms however, he was informed that MRI scanning would not be available over the weekend. Colin was reassured that the staff knew what they were doing and was told to ‘calm down’.
 
Colin did not undergo an MRI scan until 55 hours after the onset of his symptoms, by this time, it was too late and Colin was to be left with permanent disabilities.  
 
Once Colin underwent the MRI scan, he was immediately transferred for surgery at another hospital. The surgeon was experienced in treating Cauda Equina Syndrome and was surprised at the delay Colin experienced and drafted a letter to Colin’s local hospital, to highlight his concerns.
 
Colin underwent arduous rehabilitation for 10 weeks and made a complaint to his local hospital however, they responded to say that they were ‘not to blame’. Colin was annoyed and concerned at the hospital’s response.
 
Colin contacted Ian Sprakes, Head of the Clinical Negligence department at Bridge McFarland. Ian represented Colin to get the justice that he deserved. Colin received £1.32 million in compensation.
 
Colin was left with bowel and bladder problems, mobility difficulties, muscle wastage and chronic pain as a result of the delay in his diagnosis and treatment.
 
Colin felt that Bridge McFarland "dealt with my case fantastically. In fact, it couldn’t have been done any better”.