Why is Cauda Equina Syndrome a medical emergency?

Posted: 17/02/2021

Cauda Equina Syndrome occurs when the Cauda Equina nerves (the nerves at the root of the spinal cord) are compressed. Compression can occur for a number of reasons, including but not limited to degenerative changes in the spine, a slipped disc, a tumour or a spinal abscess. When the Cauda Equina nerves are compressed this normally results in what are commonly referred to as ‘red flag’ symptoms. Cauda Equina Syndrome is a medical emergency because delayed decompression surgery can result in lifelong disability.

The red flag symptoms to be alert to are:

• lower back pain;
• pain in one or both legs (often pain which radiates down the leg(s));
• leg weakness or altered 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 an individual experiences any of these symptoms, whilst they may not have Cauda Equina Syndrome, it is important that they seek medical advice. This is because if Cauda Equina compression is confirmed (usually by an MRI scan), time is of the essence and surgery to decompress the Cauda Equina nerves should ideally be performed within 24 to 48 hours from the onset of symptoms.

The 24 to 48 hour window is important because the longer the Cauda Equina nerves are compressed, the more likely any damage is going to be permanent. Damage to these nerves can result in ongoing pain, mobility issues, reduced sensation from the lower back down to the feet, urinary symptoms such as urinary incontinence, bowel issues such as chronic constipation or faecal incontinence, and impaired sexual function.

The clinical negligence team at Penningtons Manches Cooper specialises in Cauda Equina claims and, based on the team’s previous experience, those who undergo decompression surgery within 24 hours tend to have a much better outcome compared to those who do not have surgery within the 48 hour window. When surgery is delayed, the result is often significant and debilitating symptoms which in most cases will continue long term.

Penningtons Manches Cooper acts for a number of clients who suffer from permanent symptoms because decompression surgery was not performed within a suitable timespan. Delays can happen for a number of reasons: sometimes the GP does not spot the signs and so they fail to refer the patient to hospital, and sometimes there are delays due to failings whilst at the hospital – a common example is the failure to urgently perform and/or report an MRI scan.

Given how life-changing symptoms such as urinary and faecal incontinence can be, medical professionals such as GPs, A&E doctors and particularly orthopaedic and neurosurgical clinicians need to remain alert to the possibility of Cauda Equina Syndrome whenever any of the above red flag symptoms are reported. Unfortunately, as Cauda Equina Syndrome is a fairly rare condition, the right questions are not always asked in order to confirm which red flag symptoms are present and therefore whether the patient is at risk of Cauda Equina Syndrome. Even when red flags are noted, the need for urgent action is still sometimes missed.

Emily Hartland, associate in the clinical negligence team, comments: “I act for a number of clients with Cauda Equina Syndrome and in most of these cases the delay has occurred because the MRI was either not flagged as urgent or there was a delay in reporting the MRI scan to the doctor in charge of the patient’s care. Sometimes additional delays occur because the patient has to be transferred to a specialist hospital that has the facility to perform decompression surgery - providing the transfer is completed in a timely manner, this delay cannot usually be helped. It is worth seeking advice if you or a family member experience ongoing Cauda Equina Syndrome symptoms despite decompression surgery as it is possible that unacceptable delays took place and that some of these symptoms would have been improved if action was taken earlier.”

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