Cauda equina syndrome (CES) is a serious neurological condition that occurs when the bundle of nerves at the end of the spinal cord (called the cauda equina) become compressed. It is often caused by a herniated disc in the lumbar spine, although it may result from inflammatory conditions, infections or complications after spinal surgery. If symptoms are detected, treatment must begin urgently to maximise recovery and limit the risk of permanent side effects

There are many early symptoms of CES, some of which are considered red flag symptoms that must be addressed urgently. With the right treatment to relieve pressure on the cauda equina nerves, patients can make a full recovery. However, if doctors fail to diagnose the condition, refer you for relevant tests or to treat the condition properly, there can be serious long-term consequences.

If you have concerns that your condition falls into any of these categories, you may be able to claim compensation that can support your recovery and to assist with any residual disability you may be left with. The process of recovery from cauda equina syndrome will follow the same key steps, whether you are expected to make a full recovery or will be left with long-term symptoms. Here, the expert cauda equina solicitors at JMW present an infographic demonstrating the stages of cauda equina recovery, and offer advice on what you can do if you believe negligent medical treatment has made your condition worse.

Stage One: Emergency Intervention

If you are diagnosed with cauda equina syndrome, a doctor should refer you for urgent treatment.

The first stage is usually an MRI scan to confirm the diagnosis and, if corroborative, then surgical decompression to prevent permanent damage. Doctors may perform a laminectomy (removal of the arch of a vertebra), a discectomy (removal of all or part of a spinal disc) or other procedure, depending on what is causing CES.

You will be kept in the hospital and monitored for any lasting symptoms of CES.

Symptoms of CES:

• Severe sciatic back pain radiating to both legs.
• Saddle anaesthesia - numbness or altered sensation in the inner thighs, buttocks, and perineum (the areas that would sit on a saddle).
• Altered bladder or bowel function, such as urinary retention, incontinence, or the inability to sense the need to urinate or defecate.
• Sexual dysfunction.
• Weakness, numbness, or paralysis in the legs.

These symptoms may be addressed with surgical intervention, or may be permanent if diagnosis or treatment is not carried out urgently.

Stage Two: After Your Operation

You may experience pain after your operation and be given pain management support. 

Doctors will carry out neurological assessments, and monitor your bladder and bowel function and mobility. You may be given initial support, such as a walking aid, or referred for physiotherapy to improve or maximise your mobility recovery.

If bladder and bowel function does not return quickly, or is not expected to return, you may be given a catheter or bowel care support and instructed on how to use it.

Stage Three: Rehabilitation

Most patients will need ongoing physiotherapy after cauda equina syndrome, to strengthen their lower limbs and improve mobility if there has been any neurological impairment. A patient may need occupational therapy to find new ways to approach everyday tasks. Any therapies implemented are to maximise a patient’s recovery.

You may need neurological rehabilitation to recover continence and sexual function. In severe cases, some patients don’t recover these functions, and will be given medical aids or devices to support them. In these cases, rehabilitation is less about recovery and more about adjusting to your new circumstances.

Stage Four: Managing Your Condition

This stage will involve managing any lasting symptoms of your condition. Patients who experience a full recovery will be discharged from treatment during this stage, although there may be psychological side effects from what can be a distressing medical emergency.

Patients with long-term symptoms like chronic pain, bladder dysfunction, or sexual dysfunction may need emotional and psychological support to adjust to their new circumstances. Support is also available through counselling or support groups.

You may need to make adaptations to your home if you are left with paralysis, and there can be financial challenges if you are left unable to work or to do the job you previously had due to your condition.

You might also consider making a compensation claim to support your recovery.

Legal support

It’s often worth seeking legal support. Many cases of CES get worse because doctors fail to diagnose or treat the condition urgently.

A solicitor can advise you on whether or not you are entitled to compensation. This can cover many of the costs you will have to deal with during your recovery. For example:

• Private medical treatment
• Rehabilitation and physiotherapy
• Transport to and from medical appointments
• Adaptations to your home and vehicle
• Prescription medications

Compensation will also account for the pain and suffering you experienced, which could have been avoided if doctors had acted quickly.

Stage Five: Living with Cauda Equina Syndrome

The final stage of recovery involves adjusting to life with cauda equina syndrome. You may be able to return to work and activities you previously enjoyed. If you cannot, there are resources available to help you find new activities, with advice on exercise, accessibility and the other guidance you may need.

If you have decided to make a compensation claim, there will be legal and administrative steps to navigate. Working with JMW means that your solicitor will take responsibility for this, so you can focus on the other important things in your life.

You may be entitled to disability benefits or have ongoing care needs to arrange. Some people affected by CES decide to devote their time to raising awareness or campaigning for advocacy.

Whatever you decide to do, it’s also important to reflect on your successes throughout the recovery process to help you adapt to living with CES.

When Can You Claim Compensation?

If substandard medical care has resulted in a delay in diagnosis or treatment that has made your condition worse than it should have been, you may be entitled to claim compensation. CES is considered a medical emergency, and a failure to act promptly can lead to irreversible damage. The cauda equina nerves are responsible for sending and receiving messages to and from the lower limbs and pelvic organs, including the bladder and bowel. This means that a delay or failure to diagnose or treat the condition can result in incontinence, paralysis and other serious, permanent symptoms.

A medical negligence claim may be possible where the actions (or inactions) of a doctor, surgeon or other medical professional fell below the expected standard of care and caused a deterioration in your condition.

The team at JMW has a wealth of experience in supporting people with cauda equina syndrome and helping patients who believe their concerns have been ignored by those treating them. Led by renowned clinical negligence experts Eddie Jones and Angharad Hughes, our team includes members of the Law Society's specialist panel for clinical negligence solicitors and the Action against Medical Accidents (AvMA) solicitors panel who have been recognised for their proven expertise. Contact us today to learn more about how we can help you.

Find Out More

If you have been diagnosed with ongoing symptoms of cauda equina syndrome and are wondering what the future might look like for you, it’s important to know that it is possible to rebuild your life. JMW has produced a number of resources designed to help people living with CES to adjust and move forward with their lives.

• JMW’s Cauda Equina Syndrome Hub: find all of JMW’s resources and information about CES here.
• Ask the Expert: Q&A with Cauda Equina Syndrome Specialist Sue Paddison: physiotherapist Sue Paddison from the London Spinal Cord Injury Centre discusses the options for people with CES.
• Cauda Equina Syndrome Sexual Dysfunction: An Expert View: psychosexual therapist Michelle Donald explains how cauda equina affects sexual function and relationships.

JMW offers support beyond the legal process of claiming compensation. Thanks to our experience in working with people who have suffered from CES, we know how to make sure you get the support you need.