Cauda Equina

What is Cauda Equina syndrome?

Cauda Equina Syndrome (CES) is rare and serious condition. It is caused when a group of spinal nerves at the bottom of the spinal cord become compressed. It is a serious medical emergency requiring urgent treatment to avoid permanent neurological damage. For more information please see here.

The cauda equina is a group of spinal nerves, typically located between the L1 – L5 vertebrae of the lower back. The cauda equina nerves (from Latin, ‘Horse’s Tail’) has an important function controlling the sensory input and output of the bowels, bladder, pelvic area and controlling lower limb function.

CES is caused when the cauda equina nerves are compressed inside the spinal canal, usually at the L4 level or below. The onset of CES can be the result of the following:

  • Slipped disc
  • Spinal tumour
  • Spinal abscess
  • Trauma
  • Complications following spinal surgery

Emergency decompression surgery is usually required within 24-48 hours in order to relieve the pressure on the cauda equina in order for permanent neurological damage to be avoided.

What are the ‘red flag’ symptoms?

Prompt recognition and diagnosis of CES is dependent upon clinical assessment, including a thorough history and description of the symptoms along with imaging, usually an MRI scan.

The specific symptoms associated with compression of the cauda equina are referred to as ‘red flag’ symptoms and these occur in the early stages of CES. Prompt recognition of these is therefore essential in establishing an early diagnosis and providing treatment in order to achieve the best outcome for patients.

The following are some of the most common ‘red flag’ symptoms patients may experience:

  • Bilateral leg pain/weakness/numbness;
  • Severe lower back pain;
  • Sexual dysfunction;
  • Numbness in or around the groin, back passage and/or genitals;
  • Bladder and/or bowel problems, including both retention and incontinence of urine;
  • An altered sensation in the buttocks, legs, inner thighs, backs of the legs or feet which is severe or becomes increasingly worse.

As soon as any one of these symptoms arise, prompt assessment and treatment becomes critical.


Treatment is by means of surgery to relieve the pressure on the cauda equina nerves (decompression surgery). Surgery is typically required within 24 to 48 hours of symptoms, depending on the severity of the symptoms, to ensure the best possible outcome for the patient.

Any delay in the diagnosis and treatment of CES will lead to a less optimal outcome with permanent nerve damage.

If permanent damage is sustained, the effects can be devastating. Patients may experience some, or all of the following symptoms:

  • Bowel disturbance (medication/manual help may be required to pass a motion)
  • Bladder disturbance (use of a catheter may be required to pass urine)
  • Paralysis or weakness of the legs (resulting in limited mobility with dependence on a wheelchair or walking aid);
  • Loss of sexual function (inability to climax and/or reduced genital sensation);
  • Neuropathic pain in legs and feet of varying degrees (including severe sporadic pains);
  • Loss of sensation or abnormal sensation to the feet or legs (sensation may feel like walking on scrunched up paper and feet or legs may also feel uncomfortably cold or hot).

Further information and support

CES affects people differently. Some people may have all of the above symptoms, others may be limited to one or two symptoms and the degree and intensity will vary. Some people will need help with everyday living and be unable to work, whilst others may be able to work and be relatively independent.

However you are affected, the Cauda Equina Syndrome Association, a patient-run UK charity, can provide further information and support for people living with CES.

Medical negligence claims

Our NHS provides an outstanding service for the most part but sadly mistakes do happen. If you feel a mistake has been made leading to a delay in diagnosing and treating your cauda equina, you may be entitled to pursue a claim for compensation.

Moore Barlow has vast experience in dealing with claims involving delays in diagnosing and treating CES. We understand that bringing a case when you are living with CES is not an easy path to take, but if you have concerns about your own treatment or that of a loved one please do call us for an initial discussion.

For more information about making a medical negligence claim, see here.


View our Cauda Equina factsheet

Get in touch if you want to speak to expert medical negligence solicitors about a potential claim.