What is Cauda Equina Syndrome?
At about the level of the waist, the spinal cord ceases to be a single cord and splits into a number of smaller strands. It has the appearance of a horse’s tail, which is what the latin “cauda equina” means.
The cauda equina passes through the vertebrae, the bones of the spine. Each bone is separated by a vertebral disc, which is a small sack of fluid providing cushioning and flexibility to one’s back. It is these discs that are injured or moved when we suffer a “slipped disc”. If the disc bulges or slips at the level of the cauda equina, it can compress these nerves, leading to cauda equina syndrome (“CES”).
Cauda equina syndrome symptoms include pain and numbness affecting both legs and feet; as the condition progresses it can cause numbness in the buttocks, perineum and inside of the thighs. This is known as “saddle anaesthesia”. Eventually, if untreated, the condition will progress to cause bladder incontinence, bowel incontinence and, finally, complete paralysis below the waist.
The condition can arise gradually, over the course of several months, or very suddenly, over the space of a few hours. Most commonly, cauda equina syndrome arises and progresses over the course of a few days or a couple of weeks. It can occur through wear and tear of the back, as a result of some sort of back sprain or strain, or as a complication of spinal surgery.
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How is it diagnosed and treated?
A doctor would usually consider cauda equina syndrome in any patient with back pain and neurological symptoms in both legs. The patient would then have their sensation and reflexes tested in their feet, ankles, legs and saddle area. Usually, the tone of the muscles in the rectum would be tested too. If the doctor has any suspicion that the patient has cauda equina syndrome, they would be referred to hospital as an emergency, to be seen by a neurosurgeon.
If these findings are confirmed, the patient would usually have an MRI scan and, if this confirms the diagnosis, surgery would take place within the next 12 hours or so. The operation would usually be a “decompression” which involves removing some or all of the damaged disc, and perhaps some bone too, to relieve the pressure on the cauda equina nerves.
What is the effect of a delay in diagnosis or treatment?
The main aim, and typical outcome, of surgery is the prevention of the condition progressing any further, as well as relieving pain. Sometimes, damage that has already occurred will be reversed, but this requires surgery within hours of the development of those symptoms.
Therefore, if the diagnosis and treatment of the condition has been delayed, and if the condition has progressed further, it is likely that the patient will be left with a higher level of symptoms or disability than they would have been if surgery had been carried out sooner.
If the diagnosis is delayed until the patient is completely incontinent, then it is likely that these problems will not be reversed by surgery and will be permanent.
Common Cauda Equina Syndrome negligence claims
Pryers have brought successful cauda equina syndrome claims in the following circumstances: –
- A GP failed to recognise the key signs of impending cauda equina syndrome, such as bilateral leg symptoms and some urinary problems.
- Staff in the A&E department failed to recognise these signs and arrange imaging or a surgical opinion.
- Delay in carrying out a scan.
- A spinal surgeon failed to recognise the urgency with which the operation needs to be carried out.
- A radiologist was negligent in the interpretation of an MRI scan leading to the diagnosis being missed.
- Surgeons and nurses failed to spot the development of the condition following other spinal surgery.
Compensation in Cauda Equina Syndrome claims
The amount of compensation awarded in successful cauda equina syndrome claims varies very widely, depending on when the operation should have taken place and how much better the outcome would have been without the negligence.
In some cases, it cannot be shown that the patient would have done much better in the long-term, and they are awarded only a few thousand pounds for an extended period of pain and suffering. However, in cases where a near full recovery would probably have occurred, but instead the patient has been left incontinent and unable to walk, the level of compensation can be very high indeed.
Recent Successful Cauda Equina Syndrome claims
£380,000 for a delayed diagnosis, due to a scan being delayed
Ruth started to suffer from a loss of sensation in her bottom (saddle anaesthesia), bladder and bowel disturbance and back pain. She visited her GP and was correctly referred for an urgent MRI scan at the hospital.
Unfortunately, there was a delay in performing the scan, which caused a delay in diagnosing and treating the cauda equina syndrome.
The legal issues in the case were complex and Pryers worked with an expert neurosurgeon to prove that the hospital staff were negligent. It was alleged that, with earlier diagnosis, Ruth would have had urgent neurosurgery and would have made a good recovery. Instead, she was left with urinary incontinence and permanent leg pain, which made it difficult for her to walk.
Pryers recovered £380,000 compensation for Ruth’s pain and suffering, as well for walking aids and equipment and therapy. A large sum was obtained to fund future care and assistance to ensure that Ruth always could access the care and support she needed.
£565,000 for a GP’s failure to recognise developing Cauda Equina Syndrome
Peter developed sudden lower back pain while gardening. He couldn’t really move so his GP saw him at home. He was seen on 9 occasions over the next 3 weeks by a GP. She failed to carry out any neurological examinations and simply prescribed more and more pain relief. In spite of ever more obvious signs of cauda equina syndrome, she failed to refer the patient to hospital. Eventually, the patient became completely incontinent of urine and his wife called for an ambulance. In A&E, the condition was suspected. It was confirmed by MRI scan and he underwent surgery later that day.
Unfortunately, Peter was left with urinary problems and great difficulty walking. Our expert evidence suggested that the urinary problems would have been prevented with an earlier diagnosis and treatment, but he would have had some impaired mobility in any event.
The case was settled shortly before trial for £565,000.