Spinal Emergency – Cauda Equina Syndrome (CES)

Cauda Equina Syndrome (CES) is caused by the Cauda Equina nerves being compressed or squashed. The Cauda Equina bundle of nerves are found just above the waist, where the spinal cord finishes, and they are responsible for the supply of needs to the bladder, bowels, lower limbs, genitals and bottom.

Compression of the bundle of nerves can be caused by a number of events. The most common cause is a ruptured or herniated disc in the lower back but it can also be caused by narrowing of the spinal canal, a spinal tumour, infection or trauma from an accident.

Whatever it is caused by, CES is very serious and requires urgent medical attention; depending on how bad the compression is and how long it is left untreated, it can cause permanent damage to the nerves (neurological damage) and this can have life-changing consequences. Generally, the longer the time before intervention to stop the compression, the greater the damage caused to the nerves. Early treatment can significantly improve the chance of making a full or better recovery.

What are the red flags of cauda equina syndrome?

There are a number of red flags which should alert medical practitioners, whether in a GP or hospital setting, about the risk of CES. These are:

• Sciatica on both sides
• Weakness or numbness in both legs that is severe or getting worse
• Numbness around or under your genitals, or around your anus
• Finding it hard to start peeing, can’t pee or can’t control when you pee – and this isn’t normal for you
• You don’t notice when you need to poo or can’t control when you poo – and this isn’t normal for you

An important distinction in respect of the symptoms is when the CES is complete or incomplete. Putting it simply, when CES is classed as being ‘incomplete’, there may be some bladder and bowel dysfunction. If you lose all bladder and bowel control, it is classed as being ‘complete’ and when it becomes complete, it is more likely that permanent neurological damage has happened.

Diagnosis and treatment

If you are suffering from any of the above red flags, you should be referred for urgent investigations. Diagnosis is usually confirmed by an MRI scan or CT scan and CES is commonly treated by neurosurgeons with lumbar decompression surgery. Time is of the essence with this and treatment would need to be before the CES becomes complete to allow the best chance of recovery; there is no definite timeframe for this but the sooner the better. If the nerves are irreparably damaged, it can cause:

• Bladder and/or bowel incontinence
• Sexual dysfunction
• Paralysis

If you think you have a claim for a delayed diagnosis or treatment of Cauda Equina, please contact a member of our experienced medical negligence team on (01482) 323697.