A qualitative study of experiencing cauda equina syndrome and its aftercare in the UK

Nisaharan Srikandarajah; Simon Clark; Martin Wilby; Tony Marson; Adam Noble

doi:10.1038/s41393-025-01097-7

A qualitative study of experiencing cauda equina syndrome and its aftercare in the UK

Spinal Cord. 2025 Jun 28. doi: 10.1038/s41393-025-01097-7. Online ahead of print.

Authors

Nisaharan Srikandarajah^{1

2}, Simon Clark³, Martin Wilby³, Tony Marson⁴, Adam Noble⁵

Affiliations

¹ Institute of Systems, Molecular & Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK. nishsrik@liverpool.ac.uk.
² Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK. nishsrik@liverpool.ac.uk.
³ Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
⁴ Institute of Systems, Molecular & Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
⁵ Institute of Population Health Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.

PMID: 40581707
DOI: 10.1038/s41393-025-01097-7

Abstract

Study design: Qualitative, semi structured interviews.

Objectives: Cauda Equina Syndrome (CES) is a neurological emergency that can cause permanent disability to the lower limbs, including pain, weakness, and bladder, bowel and sexual dysfunction. There is little evidence on the lived experience of patients with different severities of CES. This study sought to address this.

Setting: The interviews were conducted with persons who had experienced CES and been operated on for this condition in the UK.

Methods: A sampling frame was used on a pre-existing database to select a maximum variation sample. Interviews were audio recorded and transcribed for thematic analysis supported by NVivo.

Results: Data saturation was achieved with 22 patients (12 female, 10 male) of whom 10 had CES-incomplete and 12 had CES-complete. Average age was 46 years and time since the operation was 62 months. Most interviews took place at the patients' home or workplace. Data analysis identified 4 main data themes: (1) Varying priorities of physical health; (2) A fragmented healthcare service; (3) The process of adjustment; and 4) Anticipatory anxiety and diminished sense of self-worth.

Conclusion: The identified themes confirm that CES can be a chronic condition, which requires holistic support to address the long-term outcomes. This highlights the importance of using the Cauda Equina Syndrome Core Outcome Set (CESCOS) in CES research studies to record these outcomes.