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Cauda Equina Syndrome (CES)

Cauda equina syndrome (CES) is a relatively rare spinal condition affecting the lower back, which can have significant long-term consequences for those affected if it is not diagnosed and treated promptly.


What is CES?

The cauda equina is a bundle of nerves that branches off from the bottom of the spinal cord. CES occurs when those nerves become damaged.

The most common cause is disc herniation (a ‘slipped disc’) in the lower back; other causes include trauma, surgery, spinal stenosis, inflammatory conditions and tumours.



What are the symptoms of CES?

Symptoms of CES include:

  • numbness between the legs (called ‘saddle anaesthesia’)
  • problems with bowel and bladder function
  • sexual problems
  • back pain and pain, numbness or weakness in both legs

These are known as ‘red flag symptoms’, which require urgent investigation. However, lower back pain and leg pain are often features of less serious back problems.

What are the stages of CES?

CES can progress gradually or rapidly; the earlier the stage at which it is diagnosed, the better the likely outcome.

The various stages of the disease have their own characteristic symptoms:

  • CES-S (suspected CES) - marked by pain or other neurological symptoms in both legs. A patient at this stage is at risk of developing CES.
  • CES-E (early CES) - patients who are experiencing saddle anaesthesia, but without urinary problems, or vice-versa.
  • CES-I (incomplete CES) - typically, these patients develop some urinary symptoms but still have bladder control.
  • CES-R (CES with retention) - these patients will no longer have sensation or control of the bladder.
  • CES-C (complete CES) - this is the final stage of CES, with complete loss of all cauda equina function.


How is CES diagnosed and treated?

CES may be suspected from the patient’s symptoms, but diagnosis will need to be confirmed by a scan - usually an MRI scan.

Sudden-onset CES is a medical emergency requiring urgent surgery, usually in the form of surgical decompression to relieve the pressure on the cauda equina nerves.

The success of the treatment depends on the severity and duration of the compression.

What are the consequences of delay?

Because of the progressive nature of CES, any delay in diagnosing and treating the condition has the potential to leave the patient with more significant long-term problems, including bladder, bowel and sexual dysfunction, and mobility issues.

How can CES patients find out more?

Helpful resources for additional information and support about CES include:

If you have suffered from CES and feel that your condition was not managed properly, you may be eligible to make a claim for compensation. You can read more about our clinical negligence claims service, or check out our case study to find out how Potter Rees Dolan helped a CES sufferer claim a significant compensation payout here.

Alternatively, you can contact us directly on 0800 027 2557.

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