Delays in diagnosing and treating Cauda Equina Syndrome continue to occur despite December 2018 recommendations for improved care

Posted: 05/08/2019

While Cauda Equina Syndrome is fairly rare, it is a very disabling condition, especially if there are delays in treatment so in December 2018 the British Association of Spinal Surgeons and the Society of British Neurologist Surgeons published some recommendations to help improve the management of suspected and confirmed Cauda Equina Syndrome.

These recommendations underline that any patient presenting with acute back and/or leg pain, together with one or more of the following symptoms, should be suspected of having Cauda Equina Syndrome and should have an emergency MRI scan:

• disturbance of bladder function ie incontinence;
• disturbance of bowel function;
• saddle sensory disturbance.

The recommendations make it very clear that once a diagnosis of Cauda Equina Syndrome has been made, decompression surgery should be undertaken at the earliest opportunity taking into account how long the patient has been experiencing symptoms as well as the potential for increased morbidity if operated on during the ‘small hours’.

In our experience, a patient who undergoes decompression surgery within 48 hours of the onset of their symptoms will have a much better outcome than a patient who has surgery after this 48 hour window has passed. Long-term symptoms can include permanent loss of bladder and bowel function, sexual dysfunction and neuropathic pain which is why it is so important for medical professionals to obtain a detailed medical history, including the timing of the onset of symptoms.

Unfortunately, despite the 2018 recommendations, we are continuing to be approached by patients who have not been investigated for Cauda Equina Syndrome and have therefore not undergone decompression surgery within the 48 hour window even though they have reported acute back or leg pain together with bladder, bowel or saddle sensory issues.

This may be because a GP has failed to recognise that these symptoms are indicative of Cauda Equina Syndrome and has therefore failed to refer the patient into hospital. In some cases the patient has gone straight to hospital but the doctor or nurse in A&E has failed to recognise the symptoms. On other occasions, even when the patient has been appropriately referred to the spinal team, there are delays in arranging scans and proceeding to surgery.

So why is this still happening? One of the possible factors is that Cauda Equina Syndrome is relatively rare. Many medical professionals such as GPs and A&E doctors may never have come across a patient with Cauda Equina Syndrome before and patients themselves may not recognise that their symptoms are in fact a medical emergency. 

In addition, while recommendations like those published in December 2018 are an important reminder to clinicians about best practice, it is not compulsory for each individual NHS trust or GP practice to update their policies in line with the recommendations, although many do.

Therefore, as well as helping patients who have been severely affected by delays to bring a clinical negligence claim, we also do our best to spread awareness of Cauda Equina Syndrome so that people know what ‘red flag’ symptoms to look out for and what investigations/treatment they should be receiving and within which timeframes.

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

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