What Is Cauda Equina Syndrome?
What Is Cauda Equina Syndrome?
What Is Cauda Equina Syndrome?
Cauda Equine Syndrome is caused by important narrowing of the spinal canal that compresses the nerve roots below the extent of the spinal cord. One in every of the more common causes of Cauda Equina Syndrome is during surgery to the lower back. In some cases, this surgery can cause a medical negligence claim.
Cauda Equine Syndrome can be caused by the subsequent:-
* Traumatic injury;
* Slipped or prolapsed discs;
* Spinal stenosis (narrowing of the conventional front to back distance of the spinal canal);
* Spinal tumours;
* Inflammatory conditions;
* Infectious conditions;
* Through medical intervention such as surgery.
Symptoms Of Cauda Equina.
The symptoms of Cauda Equine Syndrome embrace the subsequent:-
* Low back pain;
* Pain in one leg or each legs however starts in the buttocks and travels down the rear of the thighs and legs;
* Numbness in the groin;
* Bowel and bladder disturbance;
* Lower extremity muscle weakness and loss of sensation;
* Reduced or absent lower extremity reflexes.
Recognition of Cauda Equine Syndrome is usually delayed as it presents with bladder, bowel and sexual issues which are common complaints and will have a selection of causes. Additionally, patients could not mention some of these symptoms as a result of they are embarrassed regarding them. For clinicians it's necessary to document the character and timing of bladder, bowel and sexual symptoms notably if they are new and especially in those with a history of back pain and associated leg pain and to make a timely referral for correct investigation and expert treatment.
The 'red flag' symptoms for Cauda Equine Syndrome are the following:-
* Severe low back pain;
* Sciatica;
* Saddle and genital sensory numbness;
* Bladder, bowel and sexual dysfunction;
* Has not passed urine for 6 - eight hours.
In terms of management of the Cauda Equine Syndrome, it's important for the clinician to determine whether the syndrome is complete or incomplete. Where it is incomplete the patient has one or more of the following symptoms:-
* Altered urinary sensation;
* Loss of need to void;
* Poor stream or the requirement to strain.
Where the syndrome is complete, the patient experiences painless urinary retention and overflow incontinence.
Cauda Equine Syndrome generally needs urgent surgical treatment. The longer the compression continues, the a lot of seemingly there's to be long run neurological damage. In 50% of cases it can be too late when the first 4 - 6 hours of a severe central disc prolapse ensuing in complete Cauda Equine Syndrome. In those cases therefore there's a very small window of opportunity in that to attain a referral to an appropriate hospital, confirm the diagnosis by MRI scan and then proceed to a surgical decompression.
Where a patient has clinical options of Cauda Equine Syndrome and the MRI scan shows a doubtless reversible reason for pressure then surgical decompression is recommended. This operation is difficult and demanding and it carries a risk of further damage to the nerve roots.
One review that has been undertaken and which has been widely quoted suggests that intervention less than 48 hours once the onset of symptoms produces a higher outcome than intervention delayed for extended than this. Another read is that the result for both types of Cauda Equine Syndrome, particularly with retention of urine or incomplete retention, is better with surgical intervention among twenty four hours. It was noted that of 47 patients having surgery among 24 hours, eighty seven% recovered normal bladder operate whereas, of forty six patients having surgery later than twenty four hours, solely forty three% recovered normal bladder function.
It would seem that early surgery is connected to better results where a patient has incomplete Cauda Equine Syndrome but the case for Cauda Equine Syndrome with retention of urine is less certain.
The common causes of delay in diagnosing and treating Cauda Equine Syndrome are:-
* Patients who delay in seeking medical help;
* GPs not recognising the 'red flag' symptoms;
* Junior accident and emergency staff misdiagnosing the condition;
* Junior accident and emergency employees not calling for a consultant;
* Hospital delays in admission to surgical units and in arranging MRI scans and surgery among an acceptable amount and conducted by a suitably experienced team;
* Failure to warn of neurological harm prior to surgery for Cauda Equine Syndrome;
* Deficiencies in after care.
Most patients are young to middle aged and working before they develop Cauda Equine Syndrome. Their residual symptoms typically mean that they are unable to work and genito-urinary and bowel symptoms. From 1997 to 2006 the NHS addressed 107 cases in England in which patients with Cauda Equine Syndrome have been compromised by their care in hospital.
Cauda Equine Syndrome could be a comparatively rare condition. There are only regarding one hundred new cases of this syndrome annually in England but it's estimated that a minimum of ten% of those are mismanaged and involve litigation against the NHS.
Of these cases which were litigated between 1997 and 2006, in 35% of cases the primary criticism was against the accident and emergency department and in 52% against the in-patient management team.
Summary.
If you or somebody you know is plagued by or has suffered from Cauda Equina Syndrome following surgery you must seek professional medical advice from a medical negligence solicitor.
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