Cauda Equina Syndrome (CES) is a very rare spinal condition, affecting 1 to 3 in 100,000 people. It is commonly caused by biomechanical compression of the cauda equina nerves located at the bottom of the spinal cord.
As this is a rare condition, there is a relative lack of understanding about it – and where there is a lack of understanding, there are often myths.
What is Cauda Equina Syndrome?
The spine consists of multiple bones called vertebrae. Between each vertebra there are with supporting discs. The spinal cord runs through each vertebra until it reaches the lower back, before the coccyx (called the lumbar-sacral region). At this point, the spinal cord branches out into a collection of individual nerve fibres which resemble a horse’s tail – hence the Latin term, cauda equina.
Very rarely, one of the disc between the vertebra in the lumbar-sacral spine can “prolapse” and become bulged. As a result, the bulged disc can (though will not always) compress the cauda equina nerves. Where the cauda equina nerves are compressed, the following red flag symptoms manifest:
- Bilateral leg pain: nerve pain in both of the lower limbs, often precipitated from the lower back.
- Saddle numbness: tingling, numbness, or a loss of feeling in the “saddle area” (the inner thighs, genitals, perineum, buttocks, and back passage).
- Impaired sexual sensation: inability to achieve an erection / impaired vaginal sensation, or loss of sensation during sexual intercourse.
- Bladder disturbance: difficulty initiating urination, loss of the sensation of bladder fullness, loss of the feeling of needing to pass urine.
- Bowel disturbance: constipation, faecal incontinence, and loss of sensation when passing stools; often following bladder disturbance.
Download our handy guide – Moore Barlow – Cauda Equina red flag sympmtoms guide
For most patients, emergency spinal decompression surgery is required to relieve the compression on the cauda equina nerves, thereby ameliorating or resolving their symptoms.
Myth: red flag symptoms will disappear without medical treatment
CES is a time-critical condition and its symptoms will not improve without urgent intervention.
Without timely treatment, CES can result in:
- Permanently altered (or total loss of) sensation in the saddle area, genitals, buttocks, and back passage;
- Permanently altered (or absent) sexual sensation;
- Permanent symptoms of impaired bladder and bowels; and
- Permanent dysfunction of the lower limbs, or even total paralysis.
Cauda Equina Syndrome is therefore a medical emergency and must be treated without delay to avoid devastating consequences.
Myth: Cauda Equina Syndrome can only be diagnosed if all red flags are present.
Cauda Equina Syndrome can be diagnosed even if a patient has not developed all of the red flag symptoms. It is not a “tick box” exercise whereby all symptoms must be present, so CES must at least be suspected in a patient who has developed any of the red flags.
Waiting for all red flag symptoms to be present poses a significant risk that the patient’s condition will deteriorate to the point that the damage to the nerves cannot be undone. This stage of the condition is described as “CESR” – CES with urinary retention – where the bladder retains urine painlessly until overflow incontinence occurs. Where a patient has reached the CESR stage, surgical intervention is likely to have only a limited benefit.
Myth: Cauda Equina Syndrome can be diagnosed by the presence of red flags alone
Though it is true that red flags are important clinical indicators of CES, and as such it is crucial that a detailed and accurate history is taken from the patient, red flag symptoms alone are insufficient to diagnose CES.
Where Cauda Equina Syndrome is indicated, it is paramount that the treating clinician obtains MRI imaging of the spine. MRI imaging can determine whether a disc has prolapsed, thereby confirming whether the patient has CES.
Though red flags alone are insufficient to diagnose Cauda Equina Syndrome, radiological imaging alone is also not sufficient to diagnose CES. It is the presence of both red flag symptoms, and imaging demonstrating cauda equina compression, which results in the clinical diagnosis of CES.
How Moore Barlow can help
We are one of the top medical negligence teams in the country. With many years’ experience of claims against hospitals, GP’s and other healthcare providers, we have a consistently strong track record and are regarded as leaders in the field.
Cauda Equina settlements are often substantial as the effects on individuals are usually quite extensive. As well as damage to bladder, bowel and sexual function, there can be restrictions on mobility and ongoing pain, often leading to an inability to work and the need for extensive help with everyday living. The level of your disability and symptoms will generally dictate the level of settlement.
