Spinal stenosis is a common condition where the space around your spinal nerves becomes narrower over time. Many people know that cauda equina syndrome (CES) is often caused by a sudden slipped disc or disc prolapse, but fewer realise that CES can also develop slowly as spinal stenosis gets worse. Because the early symptoms can be subtle, it’s important to understand what to look out for and when to seek urgent medical help, and for medical professionals to understand that spinal stenosis can cause CES. No matter that cause of CES timely treatment is key. What Is cauda equina syndrome? At the bottom of your spine lies a group of nerves called the cauda equina - Latin for “horse’s tail.” These nerves control: Bladder and bowel function Sensation around the bottom, genitals, and inner thighs Leg strength and movement Sexual function Cauda equina syndrome happens when these nerves are squeezed or squashed so tightly that they stop working properly. It is a medical emergency. Without quick treatment to release the pressure, the nerve damage can become permanent. How can spinal stenosis lead to CES? Most people think CES can only happen as a result of a large disc prolapse and is quite a sudden event, and that does happen. However, spinal stenosis can also slowly tighten the space around the nerves. Over months or years, this narrowing can reach a point where the cauda equina nerves become severely compressed. Someone can have no clinical symptoms of cauda equina compression but on imaging or MRI scan, it might show some compression. In that situation, there is no surgical emergency, because the patient does not have any clinical symptoms of cauda equina compression and for whatever reason, despite the compression, the nerves allow normal function. With spinal stenosis, sometimes a small additional change—like a minor disc bulge, swelling, or even a flare-up of inflammation—can suddenly push symptoms over the threshold into CES. A patient moves from having no symptoms to then having red flags for cauda equina syndrome and this then becomes a surgical emergency. This is why it’s important for anyone with spinal stenosis to be aware of the warning signs. Red flags: symptoms you should never ignore If a person has spinal stenosis they should be made aware of the following symptoms and should be advised that in the event they do develop them, they should go to A&E immediately or seek urgent medical attention. These signs could indicate the onset of cauda equina syndrome: 1. Bladder problems Trouble starting to pee Losing control of your bladder Not feeling when your bladder is full Feeling like you can’t fully empty your bladder 2. Bowel problems Losing control of your bowels New constipation with loss of normal sensation 3. Numbness in the “saddle area” Loss of feeling around the: Inner thighs Buttocks Genitals The area you’d sit on if riding a bike or horse 4. Sudden leg weakness Legs giving way New difficulty walking Weakness or foot drop 5. Changes in sexual function New loss of feeling Why Fast Treatment Matters Cauda equina syndrome needs rapid diagnosis - usually with an urgent MRI scan and often emergency surgery to relieve pressure on the nerves. In cases of spinal stenosis, a person might have an MRI scan that looks the same or nearly the same as previous scans because there might have been long standing but asymptomatic, compression of the cauda equina nerves. The difference is the clinical presentation and the change in the symptoms they are experiencing. In cases of spinal stenosis, MRI scans that look the same should not be taken as reassurance that the patient does not have CES. An operation still needs to be considered to avoid further deterioration in symptoms. Delays can lead to lifelong complications, including: Permanent bladder or bowel incontinence Ongoing severe pain Weakness or numbness in the legs Loss of sexual function Reduced independence and major changes to daily life The sooner treatment happens, the better the chance of preventing long-term damage. So can spinal stenosis lead to cauda equina syndrome? Yes - spinal stenosis can lead to cauda equina syndrome, even though it may develop slowly. Education about the warning signs is key and prompt treatment when someone presents with a change in their symptoms can make all the difference in getting the urgent care required to avoid significant long-term damage. If you or a family member had spinal stenosis and experienced a delay in diagnosis of cauda equina syndrome and you would like to find out more about funded rehabilitation or making a claim for compensation, you can talk to one of our experienced solicitors, free and confidentially, by contacting us. Our downloadable guides A helpful guide on Cauda Equina Syndrome Download ↓
