Clinical negligence team settles claim for delayed diagnosis and treatment of Cauda Equina Syndrome

Posted: 27/10/2016

Penningtons Manches has settled a claim against Sussex Community Trust for a delayed diagnosis and surgery of a central spinal disc prolapse, which led to spinal nerve root compression and the development of Cauda Equina Syndrome (CES).

The Cauda Equina are the nerves located at the base of the spinal cord involved in lower limb sensation and pelvic function. CES is a rare but very serious neurological condition which usually arises from a slipped disc in the spine which compresses these sensitive nerves. If the compression is not identified quickly and resolved (through surgery to remove the pressure), permanent damage can be caused leading to altered lower body sensation, problems with mobility, and bladder, bowel and sexual dysfunction. The impact of these disabilities is often life changing.

The client had a history of lower back pain, but from December 2010 onwards her symptoms began to escalate, with bilateral leg pain reaching her feet, impairment of dermatomal sensation, mild reflex suppression in the ankles and sensory abnormality in both legs. At the time, she was undergoing community physiotherapy, but expert evidence concluded that the physiotherapists were negligent from December 2010 for failing to refer our client for an MRI scan by the beginning of January 2011.

Expert evidence was then obtained from a neurosurgeon, which concluded that if our client had undergone an MRI scan by the beginning of January 2011, it would have demonstrated a central disc prolapse compressing both the S1 nerve roots and the Cauda Equina nerve roots, before the onset of any clinical signs of CES. In the light of such radiological appearances, a prompt non-emergency spinal decompression (microdiscectomy) would have been carried out before the onset of sacral nerve root dysfunction and clinical evidence of Cauda Equina Syndrome.

As it was, our client was not referred for an MRI scan and by February 2011, things had progressed so much that she took matters into her own hands and paid for a private MRI. This immediately showed compression of the Cauda Equina nerves and she was rushed into hospital for emergency spinal surgery. Unfortunately by that stage, her symptoms had advanced to the point where she had bladder disturbance and bowel dysfunction.

The trust admitted that there was a breach of duty by the physiotherapists which resulted in a delay in identifying our client’s spinal disc protrusion, such that she ultimately presented with an incomplete Cauda Equina Syndrome. On the balance of probabilities, had this been correctly identified and treated sooner, the trust accepted that this would have led to a better outcome from the decompression surgery. The trust made no admissions about the extent of the injury suffered by our client.

The case proceeded on the issues of causation, condition, prognosis and quantum. Penningtons Manches issued High Court proceedings due to the expiry of limitation and the significant dispute between the parties based on the extent of causation.

A spinal surgeon, colorectal surgeon and psychiatrist provided expert evidence to address the impact of the delayed surgery. Our client’s case is that the negligence resulted in bowel dysfunction (impaired sensation of bowel fullness and sluggish bowels), bladder disturbance (frequency and urgency of bladder movements), increased low back pain, neuropathic leg pain and impaired lower limb sensation affecting mobility, and psychiatric injury in the form of major depression. These injuries give rise to care, aids, equipment, transportation, accommodation, medical and therapeutic needs. Further evidence was obtained from a care and occupational therapy expert and an accommodation expert in order to quantify the claim.

The extent of causation and quantum continued to be hotly disputed by the trust and the case proceeded through a court timetable to include the exchange of expert evidence on causation, condition and prognosis and quantum, and final schedule of loss / counter schedule. A settlement was reached at a round table meeting prior to the joint meetings of experts and the High Court trial, which was due to take place in February 2017.

Lucie Prothero, a solicitor in the Penningtons Manches clinical negligence team who conducted this claim and specialises in Cauda Equina Syndrome cases, commented: “Although back pain is a very common problem which is often progressive,  we do see a lot of cases where the additional warning signs of CES are missed in patients who have a history of back pain. This can lead to delayed diagnosis and surgery to urgently stop the spinal cord compression and prevent life changing outcomes, such as permanent loss of bladder, bowel and sexual function.

“This is a sad case where our client was left with significant physical and psychiatric problems due to the delayed diagnosis and treatment of her spinal disc protrusion. After a protracted dispute with the trust about the extent of her injuries caused by the delayed surgery, we are pleased that we have managed to reach an amicable settlement at a round table meeting.”

For more information on Cauda Equina Syndrome and / or pursuing a legal claim for the management of CES, click here.

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