Cauda equina means “horse’s tail” in Latin, to describe the multiple strands of spinal nerves at the lowest point of your back.

These group of nerves control your legs, bladder and bowel function and supply sensation to the perineum, genitals and inner thigh.

Cauda equina syndrome is a serious condition that develops when this group of nerves are compressed. The most common cause of compression is when a disc in the lower back slips out of place and occupies the same space as the nerves.

This condition can be broken down into two separate stages, known as incomplete and complete cauda equina syndrome.

  • Incomplete cauda equina syndrome – This is the first stage of the condition in which the nerves at the end of the spinal cord are compressed. A degree of bladder function is retained.
  • Complete cauda equina syndrome – If a patient has not undergone emergency decompression spinal surgery to treat the condition, the patient’s symptoms will get worse until there is a complete loss of bladder and bowel function (urinary and faecal incontinence).

Red Flags – When to Seek Urgent Medical Advice

The National Institute for Health and Care Excellence (NICE) lists these as:

  • Bilateral Sciatica (painful shooting pain down the length of your legs on both sides)
  • Severe or progressive bilateral neurological deficit of the legs (the shooting pains change and you begin to become numb in both legs)
  • Difficulty initiating urinary flow or impaired sensation of needing to pee
  • Loss of sensation of rectal fullness
  • Perianal, perineal or genital sensory loss (saddle anaesthesia but again, only after experiencing shooting pain or ‘paraesthesia’ first)
  • Laxity of the anal sphincter
  • Erectile dysfunction

However, any one or more of these symptoms are indicative of a range of other conditions including, but not limited to, sciatica, spinal injury/fracture, cancer or infection. If you are experiencing any of these warning signs, you should seek help immediately by going to your local Accident and Emergency Department.

Diagnosis and Treatment

Cauda Equina Syndrome requires emergency hospital admission and may require emergency surgery, because the longer it goes untreated, the greater the chance it will lead to permanent paralysis, saddle numbness and dual incontinence.

In December 2018, the SBNS (Society of British Neurological Surgeons) and BASS (British Association of Spine Surgeons) published a joint statement entitled “Standards of Care for Investigation and Management of Cauda Equina Syndrome”. It states that “the reliability of clinical diagnosis of threatened or actual CES is low and there should be a low threshold for investigation with an emergency MRI scan at the request of the examining clinician”.

Most researchers and clinicians now believe that a good outcome can be achieved in a patient who undergoes surgery within 24 to 48 hours of onset of their symptoms, whilst the best outcomes are often achieved if surgery takes place within 24 hours.


If treatment is provided whilst the patient’s cauda equina syndrome is incomplete, he/she stands a good chance of making a full recovery. However, patients with complete cauda equina will likely be left with permanent neurological deficit and any treatment will be to prevent a worsening of symptoms, rather than cure the condition.

Cauda Equina Syndrome is a time sensitive condition and every passing hour could make a huge difference to the patient’s outcome, and therefore the GP and/or Hospital may be held accountable for any delays in diagnosis or treatment. Patients should not have to suffer life-changing injuries that were otherwise avoidable ‘but for’ the GP and/or Hospital failings to correctly diagnose/delays in decompression spinal surgery.

RHL Solicitors’s experienced solicitors act for the victims of medical negligence, conducting thorough and rigorous clinical negligence investigations with the intention of establishing liability and recovering compensation, particularly if you are now unable to work due to the avoidable injury sustained.

The expert reports we disclose to the Defendant during the claim process can help to make a difference to future care. We understand that no one would wish to begin the long and emotional journey of claiming damages against the medical profession without good cause.

However, it’s crucial to ensure you get the expert legal advice and support you need. If you or your loved one have suffered a spinal cord injury which you believe to be attributable to medical negligence, contact our expert clinical negligence team who will be more than happy to discuss representing you on a ‘No Win No Fee’ agreement.