Cauda Equina Syndrome: A Comprehensive Guide

We have acted for many clients who have suffered with problems arising from cauda equina syndrome. This guide covers some of the most frequently asked questions around cauda equina syndrome, its causes, and potential consequences.

What is cauda equina syndrome?

The “cauda equina” is the name for collection of nerve roots which emerge from the end of the spinal cord.  Those nerve roots are responsible for movement and sensation in the legs as well as bladder, bowel and sexual function.

Cauda equina syndrome is a condition that can arise when those nerve roots cease to function properly. Damage to them can lead to weakness or paralysis, numbness, unpleasant pain sensations, loss of urinary or bowel continence and loss of sexual function. Those injuries can be devastating.

What causes cauda equina syndrome?

Cauda equina syndrome is often caused by pressure on the nerve roots which emerge from the end of the spinal cord, usually from an intervertebral disc prolapse (“slipped disc”), but there can be other causes.

Those nerves can only tolerate a limited period of time under pressure before they are irreversibly damaged. It is for this reason that cauda equina syndrome is treated as an emergency.

We commonly deal with cases where there have been delays in diagnosing cauda equina syndrome and relieving pressure on those nerves.  Those delays can arise from delays in GPs or doctors in local hospitals referring patients to a hospital with spinal surgery, delays in scanning a patient’s spine or simply delays in a patient proceeding to surgery to decompress the nerves.

If you have suffered injury arising from cauda equina syndrome, and are concerned about the treatment that you received, then you can speak to one of our specialist lawyers who may be able to help.

What are cauda equina nerve roots?

The spinal column is made up of a stack of bones (the vertebrae). There are usually 29 vertebrae in the spine and when they are all aligned, they create a canal that runs down from the base of the skull through the vertebrae.  It is in this canal that the spinal cord and cauda equina sit.

The spinal cord carries nerve impulses to and from the brain to the body.

The spinal cord does not run the entire length of the spinal canal. It ends at a level around the waist.  Below this point lie the nerve roots which form the nerves that carry impulses to and from the legs and which control bladder, bowel and sexual function as well as conveying nerve impulses, for example pain or temperature sensation, from the legs to the brain.

These nerve roots are known as the cauda equina (cauda equina meaning horse’s tail).  Issues that may arise from pressure on the nerve roots which send impulses to the muscles in the legs might include weakness of the foot or ankle giving rise to a foot drop, for example.

Some of the nerve roots are more fragile and susceptible to damage from compression than others and therefore some of the symptoms associated with cauda equina syndrome need to be acted upon with considerable urgency.  Typically, those are symptoms associated with altered bladder function.  For example, a change in sensation when going to the toilet, or new difficulty in starting, stopping or controlling the flow of urine could be features of cauda equina syndrome.

There can be many causes of cauda equina syndrome, but the more common ones that we see in medico-legal practice are usually related to pressure on the cauda equina nerve roots from a slipped disc or sometimes from a blood clot.

Whatever the cause, the treatment is usually surgical decompression to relieve pressure on those nerve roots.  Of course, the surgeon needs to know exactly where to operate and therefore a key step in investigating cauda equina syndrome involves obtaining an MRI scan.

It is often at this stage where we see delays in treatment.

From time to time we see cases of cauda equina syndrome that have arisen as a consequence of errors in the course of the surgery itself.

What are the Consequences of cauda equina injury?

The specific disabilities arising from a cauda equina nerve root injury may vary depending on which nerve roots have been affected.  Regardless, a cauda equina nerve root injury often has a devastating effect on the patient.

The effects of those nerve injuries are often permanent.

It may be the case that a once active and mobile individual will now suffer with weakness in one or both legs which could range from a mild foot drop (which might alter one’s ability to run) to complete paralysis.

Of course, it is entirely possible for the effects of a cauda equina injury to be profound and yet hidden.  Patients can often retain reasonably good function in their legs and appear to have little difficulty from day to day and yet have a catastrophic injury in relation to bladder and bowel management which can make one’s ability to go about everyday activities exceptionally challenging. If a patient needs to manage his or her bladder by inserting a catheter several times a day to drain urine, or has little or no sensation or warning as to when they need to open their bowels, the practicalities of everyday activities such as going to work can become exceptionally challenging.

Many of our clients have had very serious injuries following errors in the diagnosis and management of cauda equina syndrome. Securing compensation for such clients has assisted them in meeting the costs of managing those daily complications as well as coping with the financial consequences of being unable to return to work in their previous capacity.

If you believe there have been errors in the diagnosis and or the management of cauda equina syndrome with you or someone you know, please feel free to get in touch with us. You can mail us your query at mail@anthonygold.co.uk or give us a call on 020 7940 4060 and ask for a member of the Clinical Negligence team.