Failure to Diagnose Cauda Equina Syndrome

Whilst Cauda Equina Syndrome is a relatively uncommon medical problem, its consequences can be devastating for the sufferer and leave him or her with lifelong problems if it is not diagnosed and treated quickly.

What is the Cauda Equina?
The spine is made up of cervical (neck), thoracic (mid back) and lumbar (lower back) vertebrae. The spinal cord tapers to a cone shaped end near to the first of the lumbar vertebra. This cone shaped end is known, not surprisingly, as the conus. Close to the conus is a bundle of nerve roots known as the Cauda Equina.

What is Cauda Equina Syndrome? 
Cauda Equina Syndrome occurs when the nerve roots that make up the cauda equine are simultaneously compressed (for example, by a prolapsed disc in the spine). 

What are the symptoms?
The symptoms of Cauda Equina Syndrome include poor urinary flow; loss of sensation that one’s bladder is full; an inability to empty one’s bladder properly; numbness in the ‘saddle area’ (perineum) between one’s legs and numbness in the buttocks.

By the time that the sufferer of Cauda Equina Syndrome is at the stage where he/she is unable to empty their bladder and/or is completely constipated, it is estimated that he/she only has 48 hours to undergo spinal surgery to release the compression referred to above. After that it is likely that there will be irreversible nerve damage that, in the most severe cases, can leave the sufferer paralysed from the waist down. In fact, decompression surgery within the first 24 hours of these symptoms developing has been shown to be more beneficial than surgery in the 24-48 hour period, so time really is of the essence.

Our Medical Negligence team at Ince Metcalfes is experienced in handling claims for sufferers of Cauda Equina Syndrome whose symptoms would have been much less serious or avoided altogether but for the failure of the client’s doctors to diagnose and treat this condition as quickly as it ought to have been. 

What should happen?
If a GP, for example, were presented with a patient displaying symptoms of Cauda Equina Syndrome, he or she ought to pick up the telephone and speak with a member of the local hospital’s orthopaedic team and thereafter arrange a MRI scan of their patient’s lower back as a matter of urgency. By “urgency” we mean immediately. Once the scan has confirmed the compression of the cauda equina, surgery should follow within a few hours. 

If you or someone you know is suffering from the effects of Cauda Equina Syndrome as a result of delayed diagnosis and/or treatment then contact us today for a free, no obligation consultation.

For more information or to speak to one of our friendly team for your free initial consultation, please call 0117 239 8012 or complete our online enquiry form.

Frequently Asked Questions

  • What is Cauda Equina Syndrome?

    If someone is diagnosed with Cauda Equina Syndrome (CES) it means that the lumbosacral nerve roots at the bottom of his/her spinal cord (known as the cauda equina) have become squashed, usually as a result of a slipped disc (also referred to as a prolapsed disc). 

    Believe it or not, there is no universally accepted definition of CES but most experts agree that the key symptoms are:

    • Pain down the back of both legs below the knee
    • A numb feeling between the legs (known as “the saddle area”)
    • Weakness in the legs
    • An inability for the patient to tell that his/her bladder is full
    • Incontinence of urine and/or faeces
    • Loss of sexual function

    By no means does a patient have to be suffering with all or even most of these symptoms to be given a diagnosis of CES, and for those patients unlucky enough to be given such a diagnosis time is very likely to be of the essence. For example, he/she should have an MRI scan of the spine within a matter of hours, not days or weeks. If the MRI scan then confirms a compression of the cauda equina then surgery to decompress the spine (in other words stop the nerve roots from being squashed) needs to be carried out urgently. 

    Medical evidence indicates that if, by the time the patient is diagnosed with CES, he/she is already suffering with a complete loss of voluntary bladder function (in other words the patient is unable to urinate when he/she wants to and is also suffering with incontinence) then the chances of decompression surgery making much difference to that patient’s symptoms (certainly in terms of bladder function) are slim and he/she is likely to be left with significant loss of bladder control for life. 

    However, if by the time of diagnosis the patient still has at least some voluntary bladder function then that patient’s prognosis will be much better provided that decompression surgery takes place urgently (ie within 24-48 hours of when urine retention starts). 

    CES is a rare condition which many doctors (particularly GPs) will never encounter (or only encounter once or twice) during a whole career. Ignorance of the condition is not an excuse however, and it can have devastating consequences for patients due to delayed diagnosis and therefore delayed decompression. 

    If you would like to discuss anything within this article, or if you have any other questions about medical negligence claims, then please contact us and ask to speak to a member of our medical negligence team.

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