A diagnosis of cauda equina syndrome can create considerable uncertainty about work and finances. You may be wondering whether you can return to your previous role, whether you will need workplace adjustments or what happens if your symptoms prevent you from working again.

Recovery varies from person to person. Some people return to work, while others need to change their hours, duties or career plans. Where a delayed diagnosis or treatment caused additional avoidable harm, lost earnings may form part of a medical negligence claim. 

This article explains how cauda equina syndrome can affect employment, the adjustments that may support a return to work and how solicitors calculate past and future financial losses.

What Is Cauda Equina Syndrome?

The cauda equina is the bundle of nerve roots below the end of the spinal cord. Its name means “horse’s tail”, reflecting the appearance of the nerves. These cauda equina nerve roots help control movement and sensation in the lower limbs, as well as bladder, bowel and sexual function.

Cauda equina syndrome develops when these nerves become severely compressed. A large prolapsed disc is a common cause, although spinal stenosis, trauma, tumours and complications following spinal surgery can also lead to cauda equina compression.

Cauda equina syndrome is a medical emergency. Symptoms of cauda equina can include:

• New difficulty passing urine or urinary retention
• Loss of bladder or bowel control
• Numbness around the buttocks, genitals or inner thighs
• Weakness or altered sensation in one or both legs
• Severe back pain or leg pain
• Changes in sexual sensation or function

View this guide to signs of cauda equina syndrome from the NHS and learn about the basics of how the condition affects those who have it.

Anyone experiencing possible symptoms should seek urgent medical attention. Early treatment is important because, if the condition is left untreated, ongoing compression can cause permanent damage to the affected nerves.

Suspected cauda equina syndrome normally requires urgent assessment and an MRI scan to make the diagnosis. Where imaging confirms significant nerve compression, emergency decompression surgery may be needed to relieve pressure and reduce the risk of further deterioration.

However, surgery cannot always repair nerve damage that has already occurred. Recovery depends on factors including the severity and duration of the compression, the person’s symptoms before surgery and how quickly treatment takes place. A wide range of outcomes occur: some people recover well, while in severe cases the condition may lead to lasting problems with mobility, bladder and bowel function, sensation and independence.

How Can Cauda Equina Syndrome Affect Your Ability to Work?

The effect of cauda equina syndrome on employment varies considerably. It depends on the extent of the nerve damage, the person’s recovery following surgery and the physical and practical demands of their role.

Symptoms that may affect work include:

• Ongoing back or leg pain
• Neuropathic pain
• Muscle weakness or foot drop
• Reduced mobility and balance issues
• Fatigue
• Altered sensation in the lower body
• Bladder and bowel dysfunction
• A recognised psychological injury

Physical roles involving lifting, prolonged standing, driving or manual work may become difficult where a person has leg weakness, chronic pain or reduced mobility. Someone may be able to walk short distances, but need walking aids or regular rest breaks over the course of a working day.

Desk-based work can also be affected. Sitting for long periods may increase pain, while bladder or bowel symptoms may require immediate access to suitable toilet facilities. Ongoing treatment, rehabilitation and medical appointments can also affect attendance and working hours.

Some people experience a psychological impact as a result of their cauda equina syndrome. Their confidence and independence can be affected, and changes might be needed to career paths, which can all contribute to conditions such as anxiety or depression. These effects should be assessed individually rather than assuming that everyone diagnosed with cauda equina syndrome will have the same outcome.

Can You Return to Work After Cauda Equina Syndrome?

Many people do return to work following cauda equina surgery and rehabilitation. However, the timescale and type of work they can manage will depend on their individual recovery.

Returning to the same role

Some people regain enough strength, mobility and bladder and bowel function to resume their previous job. They may still experience lower-level symptoms, such as intermittent pain, reduced stamina or altered sensation, but remain able to manage their usual duties.

A phased return may help them rebuild confidence and understand how their symptoms respond to the working day.

Returning with adjustments

Other people can work but need changes such as:

• Reduced or flexible hours
• Hybrid or home working
• Altered responsibilities
• Reduced lifting or physical activity
• More frequent breaks
• Adapted equipment
• Easier access to toilet facilities

A person may also need to move into a different role with the same employer or retrain for work that places fewer physical demands on them.

Being unable to return to employment

Some people experience permanent nerve damage that prevents them from returning to their previous occupation or any form of regular employment. This may be due to serious mobility restrictions, chronic pain, bladder and bowel dysfunction, or the combined effect of several symptoms.

This outcome is not inevitable. Cauda equina syndrome covers a wide spectrum, from incomplete cauda equina syndrome with some preserved bladder function to complete cauda equina syndrome involving more extensive loss of function. The appropriate assessment must focus on the individual rather than the diagnosis alone.

When Can Lost Earnings Form Part of a Cauda Equina Claim?

Not everyone diagnosed with cauda equina syndrome will have grounds to make a cauda equina syndrome claim. A claim may be possible where the care provided by a medical professional fell below a reasonable standard and this caused additional avoidable harm.

For example, there may be grounds to investigate where a GP, emergency doctor, radiologist or spinal surgeon failed to recognise red-flag symptoms, arrange an urgent MRI scan or provide urgent treatment following a diagnosis. 

It is also necessary to show that, had cauda equina syndrome been diagnosed and treated quickly, the person would probably have experienced a better outcome. This may mean demonstrating that prompt surgery would have preserved neurological function, thereby allowing the person to return to work sooner.

Where medical negligence has reduced a person’s ability to work, compensation may include the earnings and employment benefits they have already lost, together with the remuneration and benefits they would have received were it not for the negligence occurring, right through to retirement in some cases.

What Types of Financial Loss Can Be Claimed?

The employment-related losses included in a compensation claim will depend on the person’s work history, recovery and future prospects.

Past loss of earnings

Past loss of earnings covers income lost between the medical negligence and the point at which the claim is settled or adjudicated upon by the Court.

This may include periods when the person:

• Could not work following cauda equina surgery
• Returned on reduced hours
• Received reduced sick pay
• Had to take unpaid leave
• Lost overtime, bonuses or commission
• Had to leave their role because of ongoing symptoms

Payslips, employment records and bank statements will be necessary to evidence the amount lost.

Future loss of earnings

Future loss of earnings reflects income the person is likely to lose because their ability to work has been reduced over the longer term.

This may apply where someone:

• Cannot return to their previous occupation
• Can only work fewer hours
• Must move into a lower-paid role
• Is likely to retire earlier
• Cannot maintain regular employment because of fluctuating symptoms
• Has lost the chance to progress in their chosen career

The calculation may run over many years, particularly where the person developed cauda equina syndrome at a relatively young age.

Loss of pension

A prolonged absence from work, lower earnings or early retirement may also reduce pension contributions and future pension income.

Where appropriate, this loss can be assessed as part of the claim.

Lost career opportunities

Cauda equina syndrome may interrupt education, training or career development. Compensation may therefore reflect opportunities that the person would probably have pursued had the avoidable injury not occurred.

This might include:

• A missed promotion
• Professional qualifications the person can no longer complete
• Reduced prospects of career progression
• The cost of retraining
• Lost self-employment or business opportunities

The evidence must show that these opportunities were realistic, rather than speculative.

How Is Loss of Earnings Calculated?

Loss of earnings is calculated using evidence about what the person earned before the injury and what they are now likely to earn.

Relevant documents may include:

• Payslips
• P60s and tax records
• Employment contracts
• Self-assessment returns
• Business accounts
• Pension statements
• Occupational health reports
• Evidence from the employer
• Medical records and expert reports

Medical experts assess how the person’s symptoms affect their ability to work and will comment on their ability to work. In cases where an individual is self-employed, it may be necessary to instruct a forensic accountant to calculate the loss to the business and in turn the individual, depending on how they receive their remuneration.

The calculation compares the person’s likely financial position without the negligence against their expected position following the harm sustained. 

What if You Can Work but Earn Less Than Before?

A person does not need to be completely unable to work for lost earnings to form part of a claim.

Many people with cauda equina syndrome return to employment but experience a lasting reduction in their earning capacity. This may happen where they:

• Work fewer hours
• Cannot carry out overtime or call-outs
• Move to lighter duties
• Take a lower-paid role
• Reduce their self-employed workload
• Need frequent time away for treatment
• Retire earlier than planned

For example, someone who previously carried out a physically demanding role may retrain for office-based work but earn less. Another person may return to their original job on reduced hours because pain, fatigue or bladder and bowel symptoms prevent them from completing a full working week.

A compensation claim may account for the difference between what they would probably have earned and what they can now earn because of the avoidable injury.

How JMW Supports People with Cauda Equina Syndrome Claims

Living with cauda equina syndrome can affect far more than your health. If your symptoms prevent you from working, reduce your income or change your career plans, the financial impact can be significant.

At JMW, we investigate whether a delayed diagnosis or delayed or incorrect treatment of cauda equina syndrome amounts to medical negligence and whether earlier care would have led to a better outcome. Our team obtains and reviews your medical records, builds a detailed timeline of events and works with independent medical experts to assess how the delay affected your recovery.

We also consider the wider impact on your life. This includes gathering evidence about how your symptoms have affected your employment, earnings and future career prospects. Depending on your circumstances, we may work with forensic accountants to assess your future earning capacity and calculate the financial losses resulting from the negligent care.

We understand that no two cases are the same. Some people are able to return to work with ongoing but manageable symptoms, while others experience permanent nerve damage that prevents them from returning to employment or living independently. Our bespoke and individual approach  to cases reflects your unique circumstances and the effect cauda equina syndrome has had on your life.