It may have started as back pain, the kind so many people have.
But then something changed, and it became frightening. Maybe the pain shot down both legs. Maybe your legs grew weak or numb. And then came the signs that should have set off every alarm. Numbness in your groin, your buttocks, your inner thighs, the parts that would touch a saddle. Trouble starting to urinate, or no urge at all. Or the opposite, leaking that you could not feel or control. Maybe numbness during sex, or no sensation at all.
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Article written by Brendan Lupetin, Esq. Brendan is a managing partner in the law firm of Lupetin & Unatin, a medical malpractice law firm located in Pittsburgh and serving Western Pennsylvania.
Our practice is limited to high-value catastrophic cases because that is where we can do the most for our clients and for patient safety.
So you got help. You went to the ER or to your doctor. You described the back pain and these strange new symptoms. And maybe they treated it like ordinary back trouble. Sciatica. A pulled muscle. A bad disc. Maybe they gave you pain medicine and told you to rest. Maybe they never asked about your bladder, never checked the numbness in your groin, never ordered an MRI. The whole time, something was crushing the bundle of nerves at the base of your spine.
By the time someone ordered the right scan and called a surgeon, the window may have closed. Cauda equina syndrome can cause permanent paralysis, incontinence, and loss of sexual function if it is not treated fast. Maybe you survived the surgery but are left forever changed. And you cannot stop asking: why didn’t they catch this in time?
That question matters. Cauda equina syndrome is a true surgical emergency, and the window to prevent permanent harm is short. When it is missed or treated too slowly, the harm is often catastrophic and often preventable. This article explains the warning signs that cauda equina syndrome was missed. It explains the serious harm a delay can cause. And it explains what you can do next. If any of this sounds like your story, Lupetin & Unatin is here to help.
What Cauda Equina Syndrome Is, in Plain Terms
At the bottom of your spinal cord is a bundle of nerves that fans out like a horse’s tail. Doctors call it the cauda equina, which is Latin for exactly that. These nerves control your legs, your bladder, your bowels, and sensation in the area that would touch a saddle.
Cauda equina syndrome happens when something presses on that bundle of nerves. Most often the cause is a large ruptured disc, but it can also be a tumor, an infection, bleeding, or bone pressing on the nerves after an injury. As the Cleveland Clinic explains, cauda equina syndrome is a medical emergency, and people who think they have it should get care right away to avoid lasting damage like paralysis and loss of bladder or bowel control.
The key word is time. The pressure starves the nerves. Surgery to take the pressure off works best when it is done quickly, usually within 24 to 48 hours of the warning signs. The longer the wait, the more likely the damage becomes permanent. That is why the test, an urgent MRI, and the surgery cannot wait.
Why Cauda Equina Syndrome Gets Missed
Here is the central trap. Back pain and sciatica are extremely common, and almost always harmless. Cauda equina syndrome hides inside that common complaint. A busy provider may see back and leg pain and assume a routine disc, without asking the questions that would reveal the emergency.
But doctors are trained to screen for the “red flags.” The most important are saddle numbness, new bladder or bowel problems, and leg weakness. As the medical literature makes clear in a systematic review of cauda equina red flags, clinicians should suspect the syndrome in a patient with back pain who has any of these signs, such as urinary retention, incontinence, loss of anal tone, or saddle numbness, and an urgent MRI is the way to confirm it. When those red flags are present and a doctor sends the patient home without an exam or a scan, that can be a failure to meet the standard of care.
Here are the common reasons cauda equina syndrome gets missed:
- Back and leg pain was treated as routine sciatica or a strain.
- No one asked about bladder or bowel changes.
- No one checked for numbness in the groin or saddle area.
- A rectal exam to check nerve function was never done.
- No urgent MRI was ordered, or it was put off until “regular hours.”
No surgeon was called once the red flags appeared.
Red Flags Doctors Are Supposed to Ask About and Check
These are the warning signs a careful doctor is trained to screen for. If you had any of these and they were not explored, that is worth a closer look.
- Saddle numbness. Loss of feeling in the groin, buttocks, inner thighs, or genitals, the areas that would touch a saddle. This is the hallmark sign.
- Bladder problems. New trouble starting to urinate, inability to empty the bladder, or leaking you cannot feel or control.
- Bowel problems. Loss of control of the bowels, or loss of the normal urge.
- Leg weakness or numbness. Especially in both legs, or weakness that is getting worse.
- Sexual dysfunction. New numbness or loss of sensation in the genitals.
- Severe or worsening back pain with sciatica. Often, though not always, in both legs.
A careful doctor faced with these signs should ask about bladder and bowel function, check sensation in the saddle area, often perform a rectal exam to test nerve function, and order an urgent MRI. When these steps were skipped, the diagnosis may have been missed.
Signs Your Cauda Equina Syndrome Was Missed
Below are the red flags, framed as questions about your care. If you recognize several, it may be worth a closer look.
- You Reported Bladder or Bowel Changes and Nothing Was Done. New trouble urinating, an inability to empty your bladder, leaking, or loss of bowel control are among the most serious warning signs. If you reported any of these along with back pain and no one acted urgently, that is a major red flag.
- You Had Saddle Numbness That Was Ignored. Numbness in the groin, buttocks, or inner thighs is the hallmark of cauda equina syndrome. If you described this feeling and it was not taken seriously, the diagnosis may have been missed.
- No One Asked the Right Questions or Did the Right Exam. A careful provider should ask about your bladder and bowels and check sensation in the saddle area, often with a rectal exam. If none of that happened, a critical chance to catch the emergency was lost.
- You Were Sent Home With “Just Sciatica”. Cauda equina syndrome is often mistaken for ordinary sciatica or a back strain. If you were sent home with that label while you had red-flag symptoms, the question is whether a careful doctor should have looked deeper.
- No Urgent MRI Was Ordered. An MRI is the test that finds cauda equina syndrome. When the red flags are present, it should be done on an emergency basis, not scheduled for later. If the MRI was delayed for hours or held until “regular business hours,” that delay can be devastating.
- Surgery Was Delayed After the Diagnosis. Once the diagnosis is made, surgery to relieve the pressure should happen fast. If the diagnosis was made but the surgery was delayed, that delay can be the difference between recovery and permanent harm.
- You Suffered Lasting Harm. Sometimes the clearest sign that something went wrong is the outcome itself. People treated within the window often recover. When treatment comes too late, the damage can be permanent. The next section covers the serious harm a delay can cause.
The Serious Harm a Cauda Equina Syndrome Delay Can Cause
When the pressure on the nerves is not relieved in time, the nerve damage can become permanent. The longer the delay, the more harm it does. Here are the serious injuries and outcomes a missed or delayed diagnosis can cause.
Permanent loss of bladder control. Many patients are left with lasting incontinence, or the need to use a catheter for the rest of their lives.
Permanent loss of bowel control. Lasting loss of bowel control is life-changing and deeply affects dignity and daily life.
Permanent sexual dysfunction. The nerves that control sexual function can be permanently damaged, causing numbness and loss of function.
Leg weakness and paralysis. The legs can be left weak or paralyzed. Some patients can no longer walk without help, or at all.
Permanent saddle numbness. Lasting loss of sensation in the groin and buttocks area is common after a delayed diagnosis.
Chronic, severe nerve pain. Many survivors live with constant burning or shooting pain that is hard to treat.
Inability to work and lasting disability. The combined effects often keep survivors from returning to work or to the life they had before.
Emotional trauma. The loss of control over one’s own body, and over basic functions, leaves deep wounds. Many people struggle with depression, anxiety, and grief for years.
Many of these outcomes share one thing in common. They often trace back to time that was lost. Time that doctors had to act, and did not use.
When a Missed Diagnosis Becomes Malpractice
Not every bad outcome is malpractice. Doctors do not have to be perfect, and cauda equina syndrome hides behind very common back pain. But doctors do have to meet a basic standard. That standard is the level of care a careful doctor would have given in the same situation.
To have a malpractice case, a few things usually need to be true. First, there was a doctor-patient relationship. Second, the care fell below the accepted standard. Third, that failure caused real harm. Fourth, the harm led to losses, such as medical bills, lost income, or pain and suffering.
Cauda equina cases often turn on a few key questions. Did the patient report red flags like saddle numbness or bladder changes? Did the doctor ask about them and examine for them? Was an urgent MRI ordered? Was surgery done in time? When the red flags were there and no one acted, that delay can be the heart of a strong case. You can read more on our cauda equina syndrome delayed diagnosis page. Proving it takes work, records, and the right medical experts. That is where Lupetin & Unatin comes in.
What You Should Do Now
If you think your cauda equina syndrome, or that of a loved one, was missed, take these steps.
Get the medical records. You have a right to them. They hold the timeline of what happened and when. In these cases, the timing is often the whole case.
Write down what you remember. Note when the symptoms started, especially any bladder, bowel, or saddle changes, and when you first reported them. Note what the doctors asked, examined, and ordered. Memory fades, so do this soon.
Do not wait too long to ask questions. Every state has a deadline for filing a malpractice claim. In Pennsylvania, that deadline is usually two years. There are some exceptions, but the clock can run out fast. Acting early protects your rights.
Talk to a lawyer who knows these cases. Cauda equina claims are complex. They need medical experts and a deep understanding of emergency, neurological, and surgical care. A general lawyer may not be the right fit. A firm focused on medical malpractice will know what to look for.
Frequently Asked Questions
You may not know for sure on your own. That is normal. The answer is usually in the medical records. We look at what symptoms you reported, whether the doctors asked about your bladder and bowels, whether they checked for saddle numbness, whether an MRI was ordered, and how long everything took. This condition hides behind common back pain, but the law asks what a careful doctor would have done with the same information. A careful review tells us whether the care fell below the standard. That review costs you nothing.
In most cases, the deadline in Pennsylvania is two years. Some exceptions can change the deadline, including the discovery rule and special rules for children. These rules are tricky. The safest move is to call us soon so we can protect your rights before time runs out.
Nothing up front. We work on contingency. That means we only get paid if we win money for you. There is no fee to talk with us and no fee to review your case. If we take your case and do not win, you owe us no attorney fee. This lets you seek justice without financial risk.
How Lupetin & Unatin Can Help
We are a Pittsburgh medical malpractice firm. We focus on serious injury and death from medical errors. Cases involving missed and delayed diagnosis, including spinal emergencies like cauda equina syndrome, are at the heart of our work. We know how these errors happen. We know how hospitals defend them. And we know how to hold them accountable.
We have handled catastrophic delayed-diagnosis cases involving permanent paralysis and loss of bladder, bowel, and sexual function. We understand how a treatable emergency can become a lifelong disability when the warning signs are missed and the clock runs out. We know the medicine, and we know how to prove what a careful doctor should have done.
We take a small number of cases so we can give each one real attention. We work on contingency. That means you pay nothing up front. You pay nothing unless we win. There is no risk in finding out if you have a case.
You deserve answers. You deserve to know if this suffering could have been prevented. A short conversation can tell you a lot.
Reach Out Today
Cauda equina syndrome can take away the use of your body in a matter of hours. A missed diagnosis can change everything. If any part of this article sounds like your story, please contact Lupetin & Unatin. Tell us what happened. We will listen. We will review the records. We will tell you honestly whether we think there is a case. If a hospital or doctor failed you or someone you love, you have the right to seek justice. Let us help you find out what really happened.