From this year, Cauda Equina Syndrome Awareness Day is being held on 16 October to align with World Spine Day. Set up by Claire Thornber, Cauda Equina Champions Charity strives to raise awareness and shine a spotlight on the devastating spinal condition, which often goes undiagnosed until it is too late.

What is cauda equina syndrome?

Cauda equina syndrome (CES) is a rare but serious condition where the bundle of cauda equina nerves at the base of the spinal cord become compressed. There are around 8,000 suspected cases every year, and without emergency surgical intervention, patients can suffer permanent neuropathic pain, paralysis, incontinence, and loss of sexual function. Early recognition, and rapid treatment is paramount to the individual’s recovery.

Despite its severity, CES is frequently misdiagnosed or dismissed as routine back pain. As a clinical negligence solicitor acting for countless clients who have suffered from delayed diagnosis and treatment of cauda equina syndrome, I understand the devastating impact that the ongoing symptoms can have with many of our clients being sent home from A&E or GP appointments without appropriate investigations, only to return days later with irreversible damage.

The importance of cauda equina syndrome awareness

This awareness day serves as a powerful reminder of the urgent need for early diagnosis, rapid treatment, and long-term support for those affected by this life-altering condition.

The symptoms including saddle numbness, bladder, bowel and sexual dysfunction together with neuropathic leg pain, weakness, altered or absent sensation and paralysis, can be subtle at first, but, once red flag symptoms develop, the window for effective treatment is narrow. A delay of even a few hours can mean the difference between full recovery and permanent damage.

While awareness is growing, as a clinical negligence solicitor I continue to see cases where standards fall short. Clients come to us after being misdiagnosed with sciatica, sent home without MRI scans, or left waiting for hours in A&E, resulting in preventable life changing damage

Cauda Equina Syndrome Awareness Day helps amplify the red flag symptoms, not just among the public, but also crucially among healthcare professionals such as those in GP surgery settings and emergency departments.

Red flag symptoms include:

• Altered bladder and bowel function, including changes to the flow and not feeling the urge to go, as well as incontinence

• Sexual dysfunction

• Sciatic pain in one or both legs

• Altered sensation in the bottom, groin and legs such as numbness or pins and needles.

• A sudden loss of power in the legs

Getting It Right First Time (GIRFT)

GIRFT is a national NHS England programme designed to improve the treatment and care of patients.

Unfortunately, adherence and understanding of the “Getting It Right First Time” National Suspected Cauda Equina Syndrome Pathway varies since it was introduced in 2023.

The pathway mandates an MRI scan within 4 hours where there are red flag symptoms but interpretation and appropriate assessment of the symptoms is key and, often, falls short of expected standards. Often the symptoms are misdiagnosed as simple sciatica when there is a potentially life-altering condition which requires immediate investigation and emergency treatment.

There are also other causes of cauda equina syndrome, such as surgical error, which can often be misdiagnosed as post-operative complications. Whenever red flag symptoms for cauda equina syndrome develop, they need to be investigated and acted upon as an emergency to avoid severe long-term complications.

Raising Standards

We’ve supported many clients through the legal process after delayed diagnosis or mismanagement of CES. These cases are not just about compensation; they’re about

• Highlighting systemic failures in emergency care and triage.

• Driving improvements in clinical training and hospital protocols.

• Ensuring patients receive the long-term support they need to rebuild their lives.

We’re proud to support Cauda Equina Awareness Day and continue to be a trusted partner of Cauda Equina Champions Charity to continue to raise standards in healthcare for CES through advocacy and education. We hope, as awareness is raised, the failure to act on and investigate red flag symptoms will be less common, leading to earlier diagnosis and improved outcomes for patients. We encourage everyone to join the conversation, share the symptoms and their stories to aid others in similar situations.