Cauda equina syndrome and medical negligence claims explained

Cauda equina syndrome and medical negligence claims explained

Michael Scobie, Clinical Negligence

Cauda Equina Syndrome (CES) is a condition usually caused by compression of the spinal cord in the lower back (lower lumbar and sacral regions). It is a medical emergency, and without timely intervention CES can result in permanent life changing injuries including pain, immobility, bladder and bowel dysfunction, and sexual dysfunction.

How does CES present?

The most common cause of CES is a herniated or prolapsed disc, but it can also occur following spinal surgery or because of trauma or cancer. Whatever the cause, the clinical presentation is typically the same, with symptoms of:

1. Urinary retention – where the bladder fills with urine but there isn’t a normal urge to urinate
2. Urinary and/or bowel incontinence
3. Saddle anaesthesia – numbness involving the anus, genitals, and buttock region
4. Sciatica – shooting pains that start in the back and travel down the back of the leg which can affect just one side but often affects both
5. Weakness or paralysis of one or both lower limbs
6. Sexual dysfunction

The onset of these symptoms can gradually occur over weeks or months as the nerve root becomes increasingly compressed, or it can occur suddenly.

How is CES diagnosed?

Patients presenting with symptoms of CES require immediate medical assessment in hospital. An MRI scan is typically used to confirm a clinical diagnosis of CES. Once confirmed, the treatment is urgent surgery to decompress the spine, to halt the progression of neurological damage and to allow the nerves to repair.

The generally accepted view is that surgery must be undertaken at the earliest opportunity. There is no benefit to delaying surgery and it can potentially cause considerable harm with further progression of neurological damage leading to more severe and irreversible injuries. Indeed, in the worst cases, patients can be left with permanent paralysis and incontinence.

Medical negligence

The time sensitive nature of intervention in CES means that claims for medical negligence do occur. The specific circumstances leading up to a claim are variable but may include:

• A negligent delay in diagnosis of CES possibly due to a misdiagnosis, a failure to refer, or a failure to progress diagnostic investigations within a reasonable timescale
• A negligent delay in surgical intervention once CES has been diagnosed

Living with CES

Patients affected by CES often require long term follow-up and rehabilitation. Further medical intervention may be required along with a programme of pain management and rehabilitative therapy. Financial pressures may be intensified if maintaining employment becomes difficult due to issues with pain, immobility, and/or incontinence. There is also likely to be a heavy burden on family and friends to provide care and support.

How we can help

Bringing a claim for medical negligence can help with all these issues, with the potential for significant financial support as well as expert advice and organised rehabilitation.

If you are concerned that you or a loved one may have suffered an injury because of medical negligence, please do not hesitate to get in touch.