Cauda Equina Syndrome or CES is a serious type of nerve root problem. It comes about when there is compression of the nerves at the very bottom of the spinal cord. The compression of the nerves stops them from working properly and if not treated swiftly then CES may cause permanent nerve damage. Cauda Equina Syndrome gets its name from Latin, “horse’s tail,” because the nerves at the end of the spine visually resemble a horse’s tail as they extend from the spinal cord down the back of each leg.
The compression of the spinal nerves can have several underlying causes, including: any spinal condition which may compress the nerves in the lower back, most commonly a prolapsed/slipped disc or lumbar spinal degeneration; inflammatory conditions of the spine; infections in the spinal canal; spinal tumours that can put pressure on the nerves in the lower spine; an injury that penetrates the lower back; and other trauma to the lumbar spine.
The CES Association notes a number of symptoms which are regarded as ‘red flags’ and would indicate that investigation or treatment is immediately required. The ‘red flags’ are lower back pain which could be described as an aching pain in a localised area, sciatica which is pain that radiates out from your lower back and travels down your leg to your calf, saddle numbness which is a loss of feeling or a strange sensation between your legs in or around the back passage and/or the genitals and weakness in one or both legs, bladder and bowel dysfunction including any dysfunction that causes retention of urine, inability to hold urine in, or loss of rectal control or feeling when passing motion and sexual dysfunction including impotence in men. Not all of the ‘red flags’ must be present for the patient to have CES, any one or more may indicate its presence.
Symptoms of CES can occur suddenly or more gradually, developing over a few weeks or a few years. Patients with any of the above symptoms should seek immediate medical attention. Investigations usually include an MRI scan to confirm the diagnosis as an X-ray will not diagnose large central disc prolapsed compressing the Cauda Equina.
CES typically requires emergency surgical decompression as quickly as possible in order to reduce or eliminate pressure on the nerve. It is generally thought that surgery within 24 to 48 hours gives the maximum potential for improvement of sensory and motor deficits as well as bladder and bowel functioning, and most surgeons recommend surgery to decompress the nerves as soon as possible, within about 8 hours of onset of symptoms.
The prognosis for CES depends on a variety of factors, including the degree of nerve damage and how quickly the nerve is decompressed. A delay in diagnosis and effective treatment increases the risk of long-term bladder, bowel and sexual problems. Late diagnosis and a delay in treatment can also increase the risk of a permanent nerve damage affecting the legs and patients may continue to have some pain, problems with their bladder or bowel, and other dysfunctions depending on the duration and severity of symptoms prior to surgery. The outlook depends on the cause of CES and how quickly treatment can be provided.
Price Slater Gawne reperesent a number of clients with Cauda Equine type injuries where the symptoms have not been recognised soon enough by medical satff. Please contact us if you need advice about bringing a claim.