Substandard Management Of Cauda Equina Syndrome

Cauda Equina Syndrome is considered to be a medical emergency

. This means that medical professionals must recognise the symptoms without delay before proceeding to urgent surgical decompression. If there is a failure to do so, a patient may well have been the victim of substandard medical care.

What is Cauda Equina Syndrome?

Cauda equina syndrome (CES) refers to the compression of the nerve roots located at the lower most part of the spinal cord. These nerves are responsible for the motor and sensory function to the lower limbs, pelvic and sexual organs and to the perineum. There are various ways in which the roots nerves can become compressed; most commonly it will occur due to a prolapsed (slipped) disc, a fracture of the spine or by a lesion such as an abscess or tumour.

Recognising the symptoms of Cauda Equina Syndrome

CES results in a characteristic pattern of neuromuscular, urogenital and rectal symptoms. More specifically, these will include lower back pain, sciatica, saddle anaesthesia, motor weakness in the legs, reduced sensation of bladder fullness, rectal and urinary incontinence and loss of sexual function. In particular, the 'red flag' symptoms of saddle anaesthesia, recent onset of bladder or bowel dysfunction and severe or progressive neurological deficit should indicate to medical professionals that CES has started. No time should be wasted in recognising the symptoms of cauda equina syndrome, as a patient's only hope of regaining normal function is if immediate treatment is provided.

Urgent treatment of Cauda Equina Syndrome

If a patient is displaying the classic signs of nerve compression, an urgent MRI scan should be performed within hours to determine whether or not there is acute cauda equina syndrome. If so, surgery to decompress the nerves must be performed at the earliest opportunity. It is absolutely crucial that this is carried out while the condition is still 'incomplete' (when a patient still has a degree of bladder function). This will greatly improve the patient's prospect of recovery. As soon the condition progresses to 'complete', (when a patient has no bladder control), the extent of nerve damage will be severe. The impact of surgery will subsequently result in little or no improvement to a patient's symptoms.

Substandard management of Cauda Equina Syndrome

The sooner a patient with incomplete CES is operated on, the greater the likelihood that they will retain bladder function. If there is a delay, a patient will sustain irreparable nerve damage, resulting in serious long-term complications such as bladder/bowel incontinence, loss of sensation and even paralysis. If this delay is the direct result of medical failings - for example, because medical professionals did not recognise the signs of CES or did not believe treatment to be urgent - then the standard of medical care will have fallen to a substandard level. The injured patient will therefore be entitled to make a medical negligence claim against the GP or hospital trust in question.

by: Julie Glynn

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