Cauda Equina Syndrome: a rare but serious condition

Posted: 25/02/2020

Unlike other well-known back conditions such as sciatica and scoliosis, Cauda Equina Syndrome (CES) is relatively unheard of. This is in part because it is an uncommon condition, and also because – providing it is diagnosed and treated quickly – there is often a positive outcome for the patient. However, because of its rarity, it is often misdiagnosed or diagnosis and treatment are delayed; and in these circumstances, patients can be left with lifelong debilitating injuries.

What is Cauda Equina Syndrome?

CES occurs when the nerves in the root of the spinal cord (known as the Cauda Equina nerves) are compressed. Compression may occur due to:

• degenerative changes in the spine;
• a spinal tumour;
• a spinal abscess;
• surgical errors; or
• accidents which result in back injuries such as a fracture or slipped disc.

When compression occurs, this normally results in at least one of the following ‘red flag’ symptoms:

• lower back pain;
• pain in one or both legs (often sciatic pain, which is pain radiating down the legs);
• leg weakness or alerted sensation in one or both legs;
• foot drop;
• reduced sensation around the ‘saddle’ area such as the groin, genitals, anus and buttocks;
• loss of or altered control of bladder function;
• loss of or altered control of bowel function; and
• loss of or altered sexual sensation or function.

If a patient reports any of these symptoms, particularly sensation issues in the saddle area or problems with the bladder and bowel, clinicians should immediately consider CES as a possible diagnosis.

How is it diagnosed and treated?

If CES is suspected, an urgent MRI scan is required to determine whether or not the Cauda Equina nerve is being compressed. If so, urgent surgery is required in order to release the compression. Timing is key because the longer the Cauda Equina is compressed, the less likely it is to recover and that is why delayed treatment can result in lifelong symptoms.

Symptoms after decompression surgery

There are two main stages of CES, which are as follows:

• Cauda Equina incomplete (CESI) – in this scenario, the patient is likely to still be able to control their bladder and bowel but will have some disruption of function and will be unable to feel any sensation when they are urinating or passing a stool; and
• Cauda Equina complete (CESR) – in this scenario, the patient is unable to control their bladder or bowel, meaning they are incontinent.

Generally speaking, if decompression surgery takes place within 12 to 24 hours of the patient developing symptoms and if they have not lost full control of their bladder or bowel, surgery should result in a fairly positive outcome. This means that whilst the patient may still have some ongoing lower back and leg pain, the rest of their symptoms should fully resolve.

If surgery takes place between over 24 to 48 hours after the patient’s first symptoms develop or after they have lost control of their bladder or bowel, the symptoms can be irreversible and the patient is likely to suffer from:

• life-long urinary issues such as incontinence and the need to self-catheterise;
• life-long bowel issues such as incontinence and/or constipation;
• loss of sexual function and sensation;
• neuropathic leg pain; and
• lower limb weakness.

These physical symptoms often also have a significant impact on the patient’s mental wellbeing.

When and how do you make a Cauda Equina claim?

Emily Hartland, an associate in the clinical negligence team at Penningtons Manches Cooper, comments: “Our team acts for a number of clients who have presented to their GP or to A&E with ‘red flag’ symptoms, and, despite having reported symptoms that are indicative of CES, decompression surgery has been delayed and they have had to live with the lifelong physical and mental symptoms of CES as a result.   

“We are often contacted because despite surgery, claimants continue to have ongoing urinary and/or bowel symptoms. During the initial consultation, as much information as possible is gathered from the client and if a delay appears to have occurred, we start by obtaining a full copy of their medical records. If on review of the records there is a consensus that there may have been delays, medical experts are instructed. The type of expert opinion referred to will depend on the concerns we have – for example, if the GP failed to refer the patient into hospital, a GP expert would need to be instructed.

Providing the experts are of the view that negligent delays did occur and these delays either caused or materially contributed to some or all of the client’s symptoms, the claim can be presented to the defendant – in most instances this is either a GP or an NHS trust. It is at this stage that the claim can be valued, and we would subsequently endeavour to obtain compensation for the injuries that have occurred as a result of the negligent treatment received.”

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

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