Clinical Negligence and Cauda Equina Syndrome

What is Cauda Equina Syndrome?

Cauda equina syndrome occurs when the nerves at the base of the spinal cord become compressed. Compression of these nerves can cause bladder and/or bowel dysfunction, reduced sensation in the saddle (perineal) area, and sexual dysfunction, with possible neurological deficit in the lower limb (motor/sensory loss, reflex change).

What causes Cauda Equina Syndrome?

Cauda Equina Syndrome can be caused by:

  • herniation (bulging) of a spinal disk in the lumbar area that presses on the nerves (the most common cause).
  • Narrowing of the spinal canal (stenosis).
  • A spinal lesion or tumour.
  • A spinal infection, inflammation, haemorrhage or fracture.
  • A complication from a severe lumbar spine injury such as a car crash, fall or other traumatic injury such as a stabbing.
  • A birth defect such as an abnormal connection between blood vessels (arteriovenous malformation).

Cauda equina syndrome is a medical emergency and requires immediate referral for investigation. Early diagnosis and early surgical decompression are crucial for a favourable outcome in most patients with cauda equina syndrome.

What are the symptoms of Cauda Equina Syndrome?

There can be a delay in diagnosis of this condition due to the fact patients present with some symptoms which can have a variety of causes. Given some of the symptoms, such as bladder, bowel and sexual problems, patients can sometimes be embarrassed to reveal such symptoms. However, if a patient does present with these problems it is important the symptoms and the timing are documented, especially if the patient has a history of back pain and leg pain. It is essential prompt investigations and treatment is commenced.

Symptoms for this condition include:

  • Severe lower back pain;
  • Numbness in groin;
  • Paralysis in one or both legs;
  • Rectal pain;
  • Loss of bladder control;
  • Loss of bowel control;
  • Pain in the sides of your thighs;
  • Sexual dysfunction;
  • Unable to pass urine for several hours

It is essential for the medical professional to establish whether the condition is complete or incomplete. If the condition is incomplete the patient will still experience some sensations such as:

  • Poor stream or the need to strain when urinating;
  • Altered urinary sensation;
  • Loss of desire to void.

However, when the condition is complete, the patient does not experience certain sensations such as they cannot feel pain despite the fact there is urinary retention, and there is overflow incontinence.

How is Cauda Equina Syndrome diagnosed?

If it is suspected a patient may have Cauda Equina syndrome there are some tests which can be done to confirm this diagnosis:

  • It is essential a detailed medical history should be obtained by the medical professional including details of the symptoms the patient is experiencing.
  • The medical professional should examine the patient to assess sensation, reflexes, etc.
  • Blood tests may be performed
  • An MRI may be performed of the patient’s spine
  • An x-ray can also be done of the spine which uses a dye which is used to visualise the spinal canal to see if and where there may be pressure on the spinal cord or nerves
  • CT scan

If this condition is suspected it is essential that such tests and investigations are performed as a matter of urgency and that they are reviewed to confirm the diagnosis and to arrange the treatment immediately.

What is the treatment for Cauda Equina Syndrome?

When a patient has Cauda Equina Syndrome time is of the essence to provide treatment to enable them to make the best possible recovery. The longer the delay in treatment commencing the longer the compression continues and therefore the greater the long term neurological damage.

In order to treat this condition surgery is required to relieve pressure on the nerves within the spine. It may also be necessary for the patient to be prescribed corticosteroids to reduce swelling. If this condition has been caused by an infection it may be necessary for antibiotics to be prescribed. Alternatively, if the condition has been caused by a tumour, chemotherapy or radiation therapy may be required after the surgery.

How can negligence occur when a person has Cauda Equina Syndrome?

Clinical Negligence may occur when treating a patient with Cauda Equina Syndrome if:

  • There has been a delay to recognise warning signs of this condition;
  • The medical professionals have misdiagnosed your symptoms;
  • There have been delays in arranging investigations;
  • There has been a delay in performing surgery urgently;
  • If a patient has undergone surgery and they are at risk of developing this condition, and there has been a failure to warn the patient of warning signs for this condition;
  • There has been a failure to refer the patient to be examined by a consultant.

If you have suffered from Cauda Equina syndrome and you are concerned that you may have experienced clinical negligence please contact us for a free no obligation chat.