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What is Cauda Equina Syndrome?

What is Cauda Equina Syndrome?

Translated from Latin, Cauda Equina literally means ‘horse’s tail’ – and describes the nerve roots that descend from the bottom of the spinal cord.

Cauda Equina Syndrome (CES) happens when those nerves are compressed. This can result in a loss of muscle power in the legs, as well as loss of bowel and bladder control and sexual function.

Compression can be caused by: a prolapsed (‘slipped’) disc, infections of the spinal canal including abscesses, tumours, and also trauma, spinal anaesthesia, and lumbar punctures.

What are the first signs of Cauda Equina Syndrome?

No one group of individuals are particularly at risk of developing the condition, other than say those that lift heavy objects. Some patients, commonly middle-aged men, may experience either acute or progressive symptoms of weakness in the legs, numbness in the area around the anus, an inability to urinate as well as loss of bowel control and/or erectile dysfunction. Some patients may also describe shooting pains in their legs.

Can it be easily diagnosed?

Whilst cases with a sudden onset of symptoms are easier to diagnose, cases where the symptoms are gradual are trickier to diagnose. Prompt diagnosis and treatment is essential to avoid or minimise permanent injury.

A common cause for a late diagnosis of CES is where patients who may have initially complained of backache, were not warned by their GP that if they developed other symptoms, such as numbness, bladder, or bowel disturbances, that they should seek urgent medical attention.

Can Cauda Equina Syndrome be misdiagnosed?

Occasionally the original diagnosis is wrong, such as when elderly patients who see their GP/attend A&E describing an onset of falling over or unsteadiness. There are a number of medical reasons that might cause this, and sometimes weakness in the legs may not be recorded. Ideally, all patients who present ‘off their feet’ should have a;

  • neurological assessment, that should include testing sensation in the ‘saddle area,’
  • checking that there is no urinary retention,
  • and whether there is loss of anal tone (by performing a rectal examination).

The findings should be recorded in the notes. The diagnosis needs to be confirmed by either an MRI scan of the spine, CT scanning, or X-ray myelogram. Urgent discussion and referral to a neurosurgical centre needs to then be made, and treatment should be within 48hours. The best chance of salvaging bladder and bowel function is if surgery is within this time frame.

Medico-legal issues:

  • Cauda Equine Syndrome is a rare condition, but prompt diagnosis and treatment needs to happen within 48 hours to minimize permanent injury;
  • Recurring or lingering backache should raise suspicions;
  • The onset of loss of groin sensation, loss of bladder and bowel function should prompt urgent detailed clinical examination and investigation;
  • If CES is suspected, urgent radiological investigation should take place.

If you want further information about this topic, or wish to discuss the possibility of bringing a claim for Clinical Negligence - or indeed any other type of injury, contact Swain & Co on 02392 483322 or email

NB This article does not constitute legal advice and should not be relied on as such. No responsibility for the accuracy and/or correctness of the information and commentary set out in the article, or for any consequences of relying on it, is assumed or accepted by any member of Swain & Co solicitors.

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