§ GUIDE · CAUDA EQUINA

Cauda equina claims,
and what decides them.

Cauda equina syndrome is a surgical emergency: pressure on the nerves at the base of the spine that can cause permanent bladder, bowel and sexual dysfunction within hours. Claims are common and often unsuccessful. These two judgments show precisely why.

Spellman agreed damages

£300,000

Recovered in Spellman

£0

Hepworth schedule

Over £5M

Recovered in Hepworth

£0

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§ THE RED FLAGS

The symptoms that turn back pain into an emergency.

Where these appear, the expected response is urgent imaging and, if compression is confirmed, decompression surgery at the earliest opportunity. Delay costs function that does not come back. That is why so much of the litigation turns on a single consultation and a single scan.

  • Numbness in the saddle area: the parts of you that would touch a saddle.
  • New difficulty passing urine, loss of the sensation of needing to go, or incontinence.
  • Bowel disturbance or loss of control.
  • Numbness, weakness or sciatica affecting both legs rather than one.
  • Loss of sexual sensation.

§ WHAT WAS ASKED, AND WHAT WAS ANSWERED

Safety-netting questions decide GP claims.

In Hepworth v Dr Coates [2025] EWHC 1907 (KB) a 27-year-old flight attendant saw her GP with severe back and leg pain, having mentioned perianal numbness in a message two days earlier. She had emergency decompression surgery four days after the consultation and was left with permanent bladder dysfunction requiring self-catheterisation, bowel dysfunction, neuropathic pain and foot drop. Her schedule of loss claimed special damages of more than £5 million.

The judge accepted that the GP asked the right red-flag questions and that the patient answered no to them on the day. The alleged breach of duty was not made out and the claim failed. The case turned on contemporaneous notes and messages, on both sides.

§ WHAT THE SCAN SHOWED

If it was not there to be seen, missing it is not negligence.

In Spellman v Portsmouth Hospitals University NHS Trust [2024] EWHC 2011 (KB) the claimant alleged a radiologist missed cauda equina compression on an MRI taken the day after a fall, delaying diagnosis until private surgery six days later. Damages had been agreed at £300,000, payable only if she proved breach and causation.

Sweeting J examined the imaging evidence and concluded there was no radiological evidence of cauda equina compression. Because it was not there to be found, reporting the scan as showing mild stenosis was an accurate assessment rather than a breach of duty. The agreed £300,000 was never paid.

§ WHAT THIS MEANS IN PRACTICE

Records first, then experts, then the claim.

Write down what you reported

Your account of which red flags you described, and when, is the heart of the case. Messages to the surgery, 111 records and triage notes can be decisive.

Get the imaging, not just the report

Where the allegation is a missed finding, the court looks at the scan itself with expert radiology evidence, as it did in Spellman.

Agreeing damages does not agree liability

Parties often agree the value and fight only breach and causation. Losing on liability means recovering nothing, however large the agreed figure.

Act quickly on the time limit

Usually three years from the treatment or from when you first knew something had gone wrong. Cauda equina claims need expert evidence that takes months to obtain.

§ THE JUDGMENTS BEHIND THIS GUIDE

Two cauda equina judgments.

Both claims failed, one against a GP and one against a hospital radiology department, and both show what the court examines.

Claim failed

Karen Spellman v Portsmouth Hospitals University NHS Trust

[2024] EWHC 2011 (KB)·2024·Liability decided at trial

Ms Spellman alleged a hospital radiologist missed cauda equina compression on an MRI scan taken the day after her fall, delaying diagnosis until private surgery six days later. Damages had been agreed at £300,000 if she won, but the judge found the scan showed only mild stenosis with no compression to be found, so the claim failed.

Parties sometimes agree the damages figure in advance and fight only liability, so a claimant who loses on breach of duty recovers nothing. Expert evidence on what the scan actually showed was decisive.

Claim failed

Rebecca Hepworth v Dr Amanda Coates

[2025] EWHC 1907 (KB)·2025·Liability decided at trial

A 27-year-old flight attendant saw her GP with severe back and leg pain, having mentioned perianal numbness in a message two days earlier; she had emergency surgery for cauda equina syndrome four days after the consultation. The judge accepted that the GP asked the right red-flag questions and that the patient answered no, so there was no breach of duty.

In cauda equina cases the court looks closely at what safety-netting questions the GP actually asked and what the patient answered on the day. Contemporaneous notes and messages matter greatly for both sides.

Claim failed

Jarman v Brighton and Sussex University Hospitals NHS Trust

[2021] EWHC 323 (QB)·2021·Liability decided at trial

A teacher with a back injury attended A&E and was referred for a routine MRI; the scan two weeks later showed a disc prolapse and she had emergency surgery but was left with permanent damage. The court found the registrar was not negligent in not suspecting cauda equina at that visit, and that her condition had not materially worsened during the delay.

Not every back-pain patient with some red-flag features must be scanned urgently; the court looks at the full picture presented at the time. Claimants must also prove the delay itself made the outcome worse.

Claim failed

XYZ v Warrington & Halton NHS Foundation Trust

[2016] EWHC 331 (QB)·2016·Liability decided at trial

A teenager with back pain had a lumbar microdiscectomy and afterwards developed cauda equina syndrome. She argued the surgeon should have sought a second opinion and consented her properly; the court rejected the criticisms and found the CES was a non-negligent complication.

Cauda equina syndrome can be a recognised complication of spinal surgery rather than evidence of negligence. Consent claims fail if the court accepts the surgeon gave adequate advice.

Claim failed

Hewes v West Hertfordshire Hospitals NHS Trust & Ors

[2018] EWHC 1345 (QB)·2018·Liability decided at trial

A man with back pain and new groin numbness phoned his GP, who told him to go to A&E rather than ringing the hospital orthopaedic team directly. Master Cook found the GP had credible expert support for that approach and struck out the claim against him.

Sending a suspected cauda equina patient to A&E by ambulance can be a defensible GP response. A GP claim will fail at an early stage if a responsible body of GPs would have done the same.

Claimant succeeded

Shaw v Stead

[2019] EWHC 520 (QB)·2019·Liability decided at trial

Two days after a back injury, Mrs Shaw attended an out-of-hours GP with severe low back pain, numbness and tingling in both legs, difficulty walking and a urinary accident. The judge found these red-flag signs of cauda equina syndrome were present and were missed, so the GP should have sent her straight to hospital.

An out-of-hours GP who fails to pick up cauda equina red flags (bilateral leg symptoms, bladder problems, leg weakness) and does not refer to hospital falls below the standard of a reasonable GP. A doctor's belief that he would not have missed it carries little weight if the records do not support it.

Mixed outcome

Hewes v West Hertfordshire Hospitals NHS Trust & Ors (appeal)

[2018] EWHC 2715 (QB)·2018·Appeal decision

A man with a disc problem developed cauda equina symptoms and the out-of-hours GP told him to go to A&E rather than arranging direct orthopaedic assessment; surgery came many hours later and he was left with permanent bowel and bladder problems. A Master had struck out the claim against the GP by summary judgment, but the High Court allowed the claimant's appeal so the claim against the GP could go to a full trial.

Clinical negligence claims should rarely be disposed of by summary judgment before the expert evidence has been exchanged. The ruling did not decide whether the out-of-hours GP was negligent, only that the question had to be tried.

Browse the whole case library →

Contains information licensed under the Open Justice - Licence v2.0. Judgments from Find Case Law, The National Archives. Summaries are ours; amounts only where printed in the judgment.

§ QUESTIONS

Common questions

What are the cauda equina red flags?

Saddle numbness, new bladder or bowel disturbance, bilateral leg symptoms and loss of sexual sensation. Together with back pain they call for urgent imaging and, if compression is found, decompression surgery at the earliest opportunity.

My GP did not refer me. Is that automatically negligent?

No. The court looks at what was asked and what you answered at the time. In Hepworth v Dr Coates the judge found the GP asked the red-flag questions and the patient answered no, so there was no breach of duty.

The MRI was reported as normal but I have permanent damage. Can I claim?

Only if the compression was visible on the scan. In Spellman v Portsmouth Hospitals the judge found there was nothing to see, so the report was accurate. Expert radiology evidence on the images themselves is essential.

How much are cauda equina claims worth?

It depends entirely on the residual disability, care needs and lost earnings. The two claimants here pleaded £300,000 and over £5 million respectively, and both recovered nothing because liability was not proved.

How quickly should surgery happen?

Cauda equina compression is treated as an emergency, with decompression at the earliest opportunity once confirmed. The precise timing is a matter for expert evidence in each case.

What should I do first if I think I have a claim?

Gather your records, including any messages to your GP surgery, and speak to a specialist solicitor early. The free assessment on this page and the first conversation with Tomlin & Partners cost nothing.

§ MORE GUIDES

Plain answers to the other questions people ask.

Why claims fail →

Eleven real judgments where the claim failed, and what each one teaches about proving breach of duty, causation and loss in a medical negligence claim.

Payout examples →

UK medical negligence payout examples by claim type, typical compensation ranges, and what decides the amount. Then check your own claim free.

Fatal negligence payouts →

What compensation after a death caused by medical negligence can include: the bereavement award, dependency, funeral costs and the estate's claim.

Time limits →

The 3-year time limit for medical negligence claims, the date-of-knowledge rule, and the exceptions for children, mental capacity and fatal claims.

How long claims take →

How long medical negligence claims really take, stage by stage, using official NHS Resolution timing data — and what slows a claim down.

NHS payout data →

Official NHS Resolution figures, band by band, for 2024/25.

This guide is general information about the law in England and Wales, not legal advice about your case. ClaimGavel is run by Costart Projects Ltd on behalf of Tomlin & Partners, a specialist medical negligence firm regulated by the SRA. The free assessment on this page is an AI overview to show you roughly where you stand; a solicitor confirms the position in a free, no-obligation conversation.