Patient recovers substantial damages for delay in identifying post operative Cauda Equina Syndrome

Posted: 14/11/2016

The Penningtons Manches clinical negligence team has recovered six figure damages for a patient left with permanent urinary, bowel and sexual dysfunction and mobility issues after spinal surgery.

The claimant underwent a discectomy for back and nerve pain privately on a non emergency basis. During the operation, the surgeon encountered significant bleeding and used a haemostatic material to deal with this. The material was left in the spinal canal after surgery. While there was no criticism of the fact that the claimant suffered a bleed or of the surgeon’s use of the haemostatic material, guidance on the material makes very clear that using it and leaving it in the spinal canal carries a high risk of nerve compression. Despite this, the surgeon did not provide any instructions to the claimant or the nursing staff to be alert to signs of nerve compression.

Almost immediately post operatively the claimant noticed and reported signs consistent with evolving Cauda Equina Syndrome (compression of the nerves at the base of the spine). These nerves will progressively sustain permanent damage if the compression is not relieved, meaning that the condition requires urgent diagnosis and surgery. Despite reporting what are known as ‘red flags’ of Cauda Equina Syndrome, particularly in this case altered / lost sensation in the genital and buttock area and loss of urinary control and her surgeon being aware of these symptoms, there is no evidence that the possibility of Cauda Equina Syndrome was considered and no steps were taken to investigate. A few days later she was discharged home, still complaining of these symptoms.

Shortly after her discharge, the claimant became completely incontinent. She was readmitted to the same clinic under a different surgeon. An MRI scan confirmed compression of the Cauda Equina nerves and she underwent further surgery to decompress them. During that surgery the blood soaked haemostatic material was located and removed from the spinal canal. Post operatively the claimant improved in some respects but she has been left with significant permanent disability including weakness in her legs, loss of control over urinary and bowel function, loss of sexual sensation and psychological symptoms as a result of her very limited lifestyle and the embarrassment and awkwardness of her condition. She has gone from being an active and sociable individual to someone who is largely confined to the house and her life has been very significantly affected.

When Penningtons Manches was approached by the claimant, the clinical negligence team immediately had concerns about the post operative failure to respond to her red flag symptoms of Cauda Equina Syndrome. The firm was instructed to investigate a claim against the surgeon and obtained independent expert evidence from another spinal surgeon. This surgeon believed the operating surgeon was negligent in failing to remove the haemostatic material after stopping the bleeding, not being highly alert to the significant risk of the claimant developing Cauda Equina Syndrome and not responding to clear signs that this was happening.

The claim was presented to the surgeon and his defence organisation. After significant delays, they responded to say that the claim was denied in full. Penningtons Manches therefore proceeded to investigate all aspects of the claimant’s condition, including obtaining urology, gynaecology, colo rectal and psychiatric expert evidence, and then issued proceedings against the defendant. Following service of proceedings the defendant’s defence organisation indicated a willingness to settle the claim and negotiations were commenced – resulting in a substantial settlement for the claimant.

Philippa Luscombe, partner in the clinical negligence team at Penningtons Manches LLP and head of the specialist Cauda Equina claims team, commented: “Cauda Equina Syndrome is a condition that is known to have clear red flag symptoms and requires urgent diagnosis and surgery. Timing of surgery is critical in reducing or avoiding long term damage. Our client underwent what should have been a straightforward spinal operation and has been left disabled – this should not have happened. It is difficult to comprehend why her very clear signs of Cauda Equina Syndrome were not recognised, particularly as she was at increased risk because of the questionable decision to leave the haemostatic material in the spinal canal. With prompt action, the claimant may have been left with some residual effects of the Cauda Equina Syndrome but not the problems she now has. No amount of money is really going to improve her quality of life and her upset at what happened was compounded by the delay on the part of the defendant in dealing with this case." 

Penningtons Manches advises on a number of cases involving delayed diagnosis of Cauda Equina Syndrome and has a specialist team focusing on these claims.

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