On 16 October 2025, Cauda Equina Awareness Day becomes international as it is celebrated alongside World Spine Day, with the aim of ensuring that Cauda Equina Syndrome receives the same recognition as other major spinal conditions worldwide. Stewarts is proud to support this international awareness-raising campaign, as Senior Associate Emily Goddard writes.

What is Cauda Equina Syndrome

Cauda Equina Syndrome (CES) is a rare but serious condition. At the base of the spine, there is a bundle of nerves resembling a horse’s tail, known as the cauda equina. CES arises when those nerves become compressed. CES will often develop suddenly, with compression of the nerves most commonly caused by a slipped disc in the base of the spine. Should CES develop, it is a surgical emergency, requiring urgent specialist assessment and intervention. If the condition is not treated quickly with surgical decompression, it can lead to a range of permanent disabilities, including permanent limb paralysis and permanent loss of bladder, bowel and sexual function, which can be devastating.

CES will often (but not always) begin with lower back pain. Red flag symptoms can include:

• sciatica in both legs
• motor weakness and/or sensory loss in both legs
• anal and/or buttock numbness
• loss of feeling between the legs (saddle anaesthesia)
• bladder retention and/or incontinence
• bowel disturbance/incontinence, and
• erectile dysfunction.

CES affects 1 to 3 per 100,000 people, with around 8,000 suspected cases every year. Unfortunately, awareness of this condition and its red flags has historically been lacking in the UK among both the public and clinicians, with life-changing consequences. CES can be mistaken for constipation or routine back pain, with those experiencing symptoms not receiving the time-critical treatment required. Approximately 23% of claims for spinal cord injury in England relate to CES.

Pathway for suspected Cauda Equina Syndrome

In 2021, a Healthcare Investigation Safety Branch (HSIB) review of the management of CES recommended the development of a national pathway for suspected CES to help reduce variation in treatment and improve outcomes. A multidisciplinary group of more than 60 clinicians was tasked with creating this pathway. As a result, the National Suspected Cauda Equina Syndrome Pathway came into force in February 2023.

The pathway aims to provide clinicians working in all care settings with the ability to better diagnose and care for patients presenting with suspected CES. The pathway stipulates that if a patient presents with suspected CES, an emergency MRI should be undertaken as soon as possible, and certainly within four hours of a request to radiology. Surgery should be undertaken as quickly as possible and within 24 hours of MRI imaging.

Since the pathway was implemented, an audit at Medway Hospital showed that while the four-hour target from radiology request to MRI was being met, there remained delays between arrival at A&E and the request for a scan. As a result, in May 2025, further improvements were recommended, including the development of a 24-hour emergency MRI service within district general hospitals.

Challenges remain in standardising and expediting treatment for those with CES, and patients are continuing to turn to us in circumstances where they have suffered lifelong disability due to failures in awareness and timely recognition of CES. However, the implementation of a national pathway, similar to that previously put in place for meningitis and sepsis, represents positive progress in improving patient care.

Better patient awareness of CES more generally is also vital, enabling patients to recognise red flag symptoms and seek urgent medical advice. More information about the pathway can be found here.

Cauda Equina Champions Charity

CES Awareness Day was established by Cauda Equina Champions Charity in 2020. Since then, it has become a major, patient-led event, seeking to highlight red flag symptoms, educate clinicians and provide a community for the thousands affected by CES. It is so important that CES Awareness Day is now established as an international event, raising awareness and improving outcomes globally.

Claire Thornber, Charity Founder of Cauda Equina Champions Charity, comments on the significance of the international reach of CES Awareness Day: “This is a historic moment. For the first time, Cauda Equina Syndrome is being recognised on an international platform. Our collaboration with World Spine Day means CES will no longer be a hidden crisis. It will be part of a global conversation on spinal health. Awareness saves lives, and awareness protects futures.”

Stewarts is a partner of the Cauda Equina Champions Charity.

Our clients’ stories

KH

KH presented to his local hospital in 2017 with red flag symptoms of CES. He was refused an MRI and sent home without any further investigations. Five days later, he reattended hospital with worsening symptoms, and an MRI confirmed a ruptured disc compressing his cauda equina nerves. He was left with neuropathic pain, leg weakness, right foot drop and lack of proprioception, sexual dysfunction and an overactive bladder. His injury had a significant impact on his physical and mental wellbeing and made it difficult to see his friends and family or enjoy his old hobbies.

KH instructed Stewarts to bring a claim against the hospital Trust, leading to a successful settlement for a seven-figure sum. You can read more about KH’s story here.

Bianca

Bianca sustained CES following delays in diagnosis and treatment in two separate hospitals. After suffering severe back pain and numbness in her lower limbs, Bianca attended the first hospital, where she was diagnosed with a disc prolapse and referred for urgent spinal surgery at the second hospital. There was then a significant delay in transferring Bianca, with the surgery not then happening until the following morning. Following the surgery, Bianca’s mobility was significantly impaired, she had bladder and bowel dysfunction and disabling neuropathic pain and numbness. Her injury prevented her from returning to work and she was restricted to her house due to a lack of care and support to enable her to access the community.

Bianca instructed Stewarts to bring a claim against the two hospital Trusts, securing a final settlement that will provide for her needs for the rest of her life. You can read more about Bianca’s story here.

How we can help

Stewarts has extensive experience of supporting people with CES. We do this both by representing those with claims for medical negligence, but also by working with charities such as Cauda Equina Champions, which provides community, education and support to those living with the condition.

You can find further information regarding our expertise, experience and team on our Medical Negligence page. If you require assistance from our team, please contact us today.

You can find further information regarding our expertise, experience and team on our Medical Negligence page.

If you require assistance from our team, please contact us.

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