Case Study: Cauda Equina Syndrome Red Flags Ignored

Compensation: £375,000

Tina, 39 years old, Worcester

Read case studies on settlements to the value of £4.3 Million, £2.6 Million or £2.5 Million, or read on for Tina's story.

JMW helped Tina to claim £375,000 in compensation after red flag signs of cauda equina syndrome were ignored for 4 days, leading to ongoing problems made worse by the delay in operating.

Tina had a history of lower back pain and had consulted her GP on a number of occasions. One day she had a particularly severe episode of back pain that was unresponsive to pain relief. She contacted her GP by telephone and an appointment was made for her to attend the surgery after 4 days if the symptoms had not improved.

Hospital admission

The pain continued and two days later suddenly worsened. Tina felt the urge to pass urine but was unable to stand and get to the toilet. She was seen at home by her GP who arranged for her to be taken immediately to A&E. Perineal and peri-anal sensations were noted to be intact. She was admitted for further investigations.

That evening the nurses recorded that Tina had "some altered sensation in the saddle area". Following a ward round the next day it was noted that although there were no bowel or urinary symptoms perineal sensation was reduced. The impression was of a L5/S1 disc prolapse creating pressure on the descending nerve root. The plan was for an MRI scan.

Multiple reviews

On the second day of her admission the nurses twice recorded that Tina was complaining of numbness of the thighs and perineal area and a lack of sensation to pass urine. The MRI scan taken that day showed a very large disc fragment that was close to becoming sequestrated (separated).

The following day Tina was reviewed again and it was noted that she was complaining of numbness in the lower back and thighs and that perineal sensation was also reduced. Initially she seemed to be passing urine fairly normally but later had to be catheterised for retention.


At midnight she was reviewed again as she could not pass urine. Peri-anal sensation was noted to be markedly reduced. On the ward round the following day a possible diagnosis of Cauda Equina Syndrome (CES) was made and she was listed her for urgent lumbar spine decompression the following morning. Decompression of L5/S1 was undertaken 5 days after it was first noted that there was a degree of loss of perineal sensation.

Ongoing effects

Tina experienced a number of problems following the surgery and 3 years later she had a spinal fusion because of continuing pain. She has also had a number of facet joint injections as a means of pain relief.

She has limited mobility and uses crutches or a wheelchair or a scooter when outside the house, although she spends most of her time at home. She has little bowel or bladder control and has to self catheterise. She has no sexual feeling at all and, understandably, this has affected her relationship with her husband. She is depressed and continues to experience considerable back pain. It is unlikely that she will ever work again.

The claim

JMW Solicitors claimed that the significance of the red flag signs of severe back pain associated with perineal numbness and bladder involvement went unrecognised for 4 days.The hospital admitted that it was negligent to fail to operate before 4 days in hospital and agreed that this delay had increased the severity of symptoms experienced by Tina.


Following exchange of medical evidence, Tina was offered £375,000 compensation for her claim which she accepted.

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