Last week was Back Care Awareness Week, an annual campaign organised by the charity BackCare which aims to raise awareness of the potential causes of back and neck pain and to provide information on management and support of the condition. This year’s theme was ‘back pain in education’ with a focus on young people and simple steps that can be taken to try to reduce the chances of problems occurring in the future.
Awareness and education is more important when dealing with back and neck problems than people realise. One particular example of this is Cauda Equina Syndrome. This serious neurological condition usually arises from a slipped disc in the spine. The Cauda Equina are the nerves located at the base of the spinal cord involved in lower limb sensation and pelvic function. Cauda Equina Syndrome occurs when these sensitive nerves become compressed by a slipped or prolapsed disc. If the compression is not identified quickly and resolved through surgery, 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.
Because of the speed with which Cauda Equina Syndrome can develop and the short window of opportunity to treat it effectively, swift action is critical. However, since it is relatively rare and often preceded by ‘routine’ back pain, it may be missed – with devastating consequences. Symptoms which should prompt urgent action include loss of sensation in both lower limbs, numbness in the buttocks, loss of genital sensation and bladder and bowel problems.
All primary care doctors should know of Cauda Equina Syndrome and recognise the red flags signs – but sadly sometimes they fail to do so. This may be due to not asking sufficient questions to be able to identify the symptoms or not recognising the significance of indicators reported by the patient. Because of the devastating effect Cauda Equina Syndrome can have if the patient does not undergo prompt surgery, clinical negligence claims for delayed diagnosis are often substantial, settling for many hundreds of thousands of pounds. Education on this condition would reduce the incidences of missed diagnosis with a substantial saving in claims.
However, education of doctors is not the only level at which awareness can make a difference. Many GPs are good at advising patients with back pain about red flag symptoms so that they do attend A&E urgently if these develop. Back care charities and NHS information pages now also provide material on back pain and associated symptoms to help advise patients if there is an urgency about their condition.
Philippa Luscombe, a partner in the clinical negligence team at Penningtons Manches LLP, who heads the firm’s specialist Cauda Equina Syndrome team, says: “Several of our clients have been sent away by GPs or doctors at A&E but have realised the potential significance of their symptoms after looking at the internet and have asked to be reassessed. For some it has been too late to make a difference but for others that access to information and the action they have taken as a result have meant that they have been able to improve their outcome. Education and awareness do therefore have a real part to play in managing back pain – and Cauda Equina Syndrome is a good example of this.”