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Message Cauda EquinaSyndrome (CES):What you needto know

Prepared by Julie Marsh, a specialist inmedical negligence at Boyes Turner, thisfactsheet outlines the key medical and legalissues surrounding Cauda Equina Syndrome(CES) — a rare but serious condition thatdemands urgent care.With extensive experience supporting thoseaffected by CES, Julie and the team at BoyesTurner are committed to raising awarenessand helping individuals understand theirrights when delays in diagnosis or treatmentlead to long-term harm.A helpfulguide onCaudaEquinaSyndromeboyesturnerclaims.com | Medical Negligence1

The collection of nerves at the end of the spinal cord is known as theCauda Equina.The nerve ends supply power and sensation to the lower limbs and sensoryfunction to the bladder, bowel and perineum (saddle area). Cauda EquinaSyndrome (CES) occurs when there is a severe compression of the nerveroots of the Cauda Equina. Cauda Equina Syndrome can affect any of the lower body functions thatare controlled or given sensation by the Cauda Equina nerves. For manypeople, this means CES affects their bowel, bladder and sexual function andcan impact strength and movement of the lower limbs. 2Pressure on the Cauda Equina nerves causes CES. This is almost alwayscaused by a herniated spinal disc, although very rarely tumours, infectionsand inflammation can put pressure on the nerves.What is Cauda Equina Syndrome or CES?What causes CES?About Cauda Equina Syndrome

3The warning signs are often referred to as “red flags” and commonlyinclude:Numbness in and around your “saddle” area. The “saddle” area caninvolve the anus, genitals and buttock region (anywhere that mighttouch the saddle on a bike if you were to sit on one).Urinary dysfunction. This is where your bladder fills with urine but youdo not experience the normal session of fullness or you might haveissues starting the flow of urine; the stream might be poor or you mightnot have the sensation that you have finished passing urine. You mightfeel you have emptied your bladder but then realise you need to passurine again.Urinary retention – Where you do not get the usual message to emptyyour bladder. This may be painful, or painless. Urinary and/or faecal incontinence. Weakness or paralysis of the lower limbs.Pain in the lower back and/or in the leg(s) (sciatica). What are the warning signs for CES?

Sexual problemsInability to achieve anerection or ejaculate Loss of sensationduring intercourseLoss of clitoralsensationBladder disturbanceInability to urinateDifficulty initiatingurinationLoss of sensation whenpassing urineInability to stop or controlurinationLoss of the full bladdersensation.Back pain/ Sciatica / Leg weaknessIt is quite common to have a combination of back pain, leg pain, leg numbnessor weakness. These symptoms however are common in people who have ahistory of back problems but do not have Cauda Equina Syndrome. Saddle numbnessLoss of feelingbetween the legsNumbness in or aroundthe back passage and /or genitalsInability to feel thetoilet paper whenwipingBowel disturbanceConstipationLoss of sensation whenpassing a bowel motionInability to stop a bowelmovementThis page outlines the key red flag symptoms that may indicate thepresence of Cauda Equina Syndrome. Prompt recognition and treatmentare crucial to prevent permanent nerve damage and improve outcomes. Ifyou or someone else experiences any of these symptoms, you should seekemergency medical care immediately.4What are the red flag symptoms and signs?

In February 2023, NHS England released an interactive Pathway to helpdiagnose and treat Cauda Equina Syndrome. The Pathway was reviewedand updated in October 2023. The aim of the Pathway is to speed up thediagnosis and treatment of CES. Despite the introduction of this Pathway we continue to talk to patientswho experience a delay in diagnosis of CES, and who experience delaysaccessing imaging, and ultimately, surgery. 5What is the Getting It Right FirstTime (GIRFT) CES Pathway?CES is rare and medical professionals are often not well versed inrecognising the symptoms. It is unlikely that a person will present with allthe symptoms of CES, and it is important for a neurological assessment tobe performed. An important test is to check perineal sensation and analtone. The next line of investigation is usually an MRI scan, which will showwhether there is a compression of the Cauda Equina nerves. How is CES diagnosed?

6There isn’t a simple answer to this question, as everyone’s experience isdifferent. Delays in surgery can sometimes lead to more severe damage. On theother hand, if treatment is timely and appropriate, many people do seeimprovements in their symptoms over time. Still, even with successful andearly treatment, full recovery isn’t always possible.Living with a complex condition like CES can be incredibly challenging andcan touch every part of life. The physical changes can feel overwhelming,and having strong support from medical professionals, family, and friends isso important. Beyond the physical aspects, CES can also deeply affectmental health and personal relationships, making emotional support just asessential.Are the effects of CES permanent?CES is treated by surgical decompression surgery to relieve the pressure onthe nerves. There are typically two types of surgery in this situation, adiscectomy, where a section of the damaged disc is removed or alaminectomy, where a section of bone from one of the vertebrae isremoved.The timing of the surgery is key. Timely surgery can result in a significantlyimproved outcome. Delays in diagnosis and performing surgery can resultin permanent and life changing disability. How is CES treated?6

7If you have concerns about how your CES was diagnosed, treated, or thetime it took to receive treatment, our experienced team is here to help. Ifwe are of the view that there are issues to investigate, we may suggest thatyour medical records are requested or that a formal complaint is submittedas this may provide additional information which will help us focus ourenquiries. How do I know if I have a claim for medical negligence relatedto my cauda equina diagnosis?We recommend talking the issues through with a specialist solicitor to helpyou consider whether and to whom a compliant might be made and theissues you would like the hospital / GP or other health provider to engagewith.If you have made a complaint and have questions about the response youhave received, or are not satisfied with the answers you have been given,we suggest you contact a specialist CES solicitor to discuss your options.Should I complain about the care I have received?About CES claims

8To bring a claim for medical negligence, you need to show that a medicalprofessional has failed to care for you properly and that as a result of thisfailure you have suffered an injury.CES cases are usually brought because there has been a failure or delay inthinking the presenting symptoms may be caused by CES and this hasresulted in a delay in investigation and treatment, in turn leading to a worseoutcome. Independent medical experts will consider the standard of carereceived, whether there was any negligence and whether the negligencecaused an injury. The injured person is entitled to compensation for any injury that wascaused by negligent medical care. They are also entitled to compensationfor the financial consequences of that injury. What do you need to prove to succeed with a medicalnegligence claim?

9Some of the common issues that arise in CES cases include:Should the diagnosis have been made earlier?Should an MRI scan have been done earlier?Should surgery have happened at an earlier point in time?Was a person given the right information about what “red flags” to lookout for and when to attend hospital if their symptoms got worse?Did the delay in diagnosis and treatment make a difference to theeventual outcome – i.e. whether the damage to the nerves had alreadyoccurred at the time surgery should have happened;Whether the ongoing issues are because of the negligent care or wouldthey have been present in any event (quite often lower back painwould always have continued, even if a diagnosis had been made andtreated earlier).What are the key issues in a case involving cauda equinasyndrome?There is no set amount of compensation for CES claims and thesettlements vary depending on your circumstances and your ongoingsymptoms. However due to the lasting consequences of CES, a CES claimtends to be classed as a higher value claim. What is a CES claim worth?

10Over 95% of the cases we take on settle successfully without the need fora trial. We understand the prospect of trial can be daunting and work withour clients to help manage the emotional journey. In our experience,meticulous preparation at every stage of the claim both minimises thechances of a trial being necessary and reduces the inevitable stress shoulda trial be required. In rare circumstances, we may advise our client that for the case to proceedit must go to a court hearing. Our experienced and caring solicitors andbarristers understand that this can be daunting for our clients and ensurethat our clients are kept informed and feel supported.Will I need to go to court?If you are concerned about the care you have received, please contact ourspecialist Cauda Equina Solicitors for free onmednegclaims@boyesturner.com or by phone at 0800 124 4845.We will listen to your concerns and talk you through the issues and youroptions. How do I bring a claim?

Julie is a partner within our medicalnegligence team. She specialises in highvalue and complex claims for clientswhose lives have been changed byCauda Equina Syndrome (CES). Our Medical Negligence team is rankedas leaders in their field and have over 30years experience in supporting clientsthrough injury claims.Pursuing a medical negligence claim can be a complex and emotionaljourney, and it’s important to know that it may not be the right path foreveryone. With the support of Boyes Turner’s expert medical negligenceteam, you can explore your options with confidence. Our specialist solicitors combine legal expertise with a sensitive, client-focused approach to ensure you receive the guidance, support, and, whereappropriate, the compensation you deserve.How we can helpmednegclaims@boyesturner.com +44 (0)118 959 7711Our Medical Negligence teamJulie Marsh, PartnerMedical Negligence11

We are proud to be a trusted partner of Cauda Equina Spinal Cord Injury or CESCI (www.cesci.org). This support group isdedicated to helping people living with CES find resources and accesssupport. They offer online support group meetings, in person events andmeetings and peer support from those who share their lived experience ofcauda equina syndrome. Support is also available for the partners and widerfamily of the person living with CES. In addition to support, the group is also committed to raising awareness ofthe red flags of Cauda Equina Syndrome and in educating medicalprofessionals about the impact of living with CES. 12Supporting those living withCauda Equina SyndromeBoyes Turner works with SIA to support those living with a spinal cord injury. This organisation also works closely with CESCI, andworks to support those with a spinal cord injury (SCI) lead a fulfilled life.They provide emotional, clinical and practical support and campaign forhealth equality and disability rights for those with SCI.Spinal Injuries Association (SIA)Cauda Equina Spinal Cord Injury CESCI

We secured an interim payment of£70,000 to help the client adapt hisliving conditions, and the totalsettlement will now ensure hislong-term care and enable a move tosuitably adapted accommodation.Our specialist medical negligence team has a strong track record ofachieving successful outcomes in CES cases, ensuring our clients receivethe support they need to move forward.To view our previous CES case studies, please visit:https://www.boyesturnerclaims.com/our-cases/cauda-equina-claimsOur previous cases£1,330,000 settlement for patientwith Cauda Equina Syndromefollowing GP negligenceFeatured case

Julie Marsh is a first rate litigator who adds real value to all hercases. I have always been impressed not just by her expertise as aclinical negligence lawyer but by the way she treats every clientas an individual and works on their case as if it is the mostimportant thing in the world, which to many clients it really is.From the first contact with Boyes Turner, I have received aprofessional, compassionate and first rate service. Julie Marshhas been amazing and I would recommend this firm andespecially Julie to anyone. My claim was due to a traumaticexperience which has resulted in an embarrassing condition. Ireceived so much reassurance and support and would like tothank the team for that , as well as a fantastic result!