Monday, 11 May 2015

Bolt Burdon Kemp: Cauda Equina Syndrome - A Spinal Emergency

What are the Red Flag signs and what happens if there is a delay in diagnosing or treating Cauda Equina Syndrome?

At Bolt Burdon Kemp we often act for clients who have developed Cauda Equina Syndrome (CES). Below, we explore what this condition is and when someone may be able to bring a claim for compensation.

Cauda Equina literally means the ‘horses tail.’  It refers to very bottom of the spinal cord which ‘tails’ off and contains key nerves. If these key nerves become damaged, it can affect your ability to walk, your bladder and bowel function as well as your sexual function. Any damage to these vital nerves can have devastating consequences. All medical professionals are trained to spot the tell tale signs of cauda equina syndrome so that any damage is minimised or alleviated as an emergency.

What are the Red Flag symptoms of Cauda Equina Syndrome?

CES can present with one, or with a combination, of the following red flag symptoms. Red Flag symptoms are symptoms which if present, should alert medical professionals to a potentially serious condition.

If you go to your doctor with one or more of the following ‘Red flags’, your doctor should carry out further tests. The investigations that your doctor should carry out will help your doctor confirm or exclude the presence of CES.

It is also important to note that the symptoms sometimes develop suddenly and often rapidly worsen. This deterioration can happen within hours or days, therefore it is vital that you seek medical advice as the moment you suspect something is not normal.

Time is of the essence when dealing with CES. There is a small window of opportunity in which your doctors have to try and treat the condition to avoid permanent neurological injuries. These injuries can include bowel and bladder dysfunction and incomplete paralysis.

Red Flag signs should not be ignored or dismissed and instead merit further diagnostic testing.

Red Flags:

   Saddle Anaesthesia

This is the loss of feeling between the legs and or numbness in or around back passage and/or genitals.

   Bladder Disturbance

This could present as the inability to urinate or difficulty initiating urination. There may also be the inability to stop or control urination; you may experience a loss of sensation when passing urine or you may not be able to tell when your bladder is full and may have lost this sensation.

    Bowel Disturbance

This sign typically presents as an inability to stop a bowel movement, constipation or the loss of sensation when you pass a bowel movement.

   Sexual Problems

You may experience the inability to achieve an erection or ejaculate. You may also notice a loss of sensation during intercourse.

   Nerve Root Pain

It is quite common to have a combination of back pain, leg pain, leg numbness and weakness.  However, these symptoms are also common in people who have a history of back problems but do not necessarily have CES. You should however seek medical advice if you experience these signs, particularly if you have any of the other symptoms as well.

These are all “red flag” symptoms and if a patient describes any of these symptoms then this should act as a warning to the medical professional.

What should I do if I think I have any of the symptoms?

You should go to your GP, local Walk In Centre, or A&E.

If you have one or more red flags, your GP will probably recommend that you have further tests. If you have any red flags that suggest CES, your GP will make sure you are admitted to hospital immediately.

BBK Spinal injury Advice: Stand your ground. If you feel your symptoms are abnormal, point this out to the medical advisor again. As a solicitor who acts for many clients who have developed spinal cord injuries, it is quite common for our clients or relatives to say they just accepted the advice of the doctor, without questioning it further. Quite understandably my clients trust their doctor even though they had a gut instinct something wasn't quite right.

Only you know your body best. If you feel something is not right, ensure you are taken seriously. The chances are you are probably fine but the symptoms of Cauda Equina need to be investigated and promptly considered.

Diagnosing Cauda Equina Syndrome:

When CES is suspected a medical professional should perform some simple tests which include the following:

    Checking reflexes your legs and feet
    Checking sensation to touch and pain in your feet and legs
    Performing an internal rectal examination

If the tests indicate a diagnosis of CES then you should be referred for a MRI scan to confirm the diagnosis.

Treating Cauda Equina Syndrome:

If the MRI images indicate that the nerves are compressed and cauda equina is present, then surgery should be carried out as soon as possible. The most common type of surgery for CES is a ‘Laminectomy.’  This operation involves removing part of your vertebra (backbone) which creates a space, releasing the pressure on your key nerves that have been compressed. If your nerves have been compressed for too long, it can lead to permanent, irreversible damage.

What happens if there is a delay?

Sometimes there is a delay in CES which leads to a delay in performing surgery.  If there is a delay in performing surgery the following can occur:

Permanent severe pain and discomfort
Permanent mobility problems
Permanent loss of sensation in the legs and feet
Irreversible loss of bowel and/or bladder control
Sexual dysfunction

Opinion differs as to how quickly surgery should be performed in order to reverse any neurological damage that may have occurred.

It is generally agreed that there is a window of opportunity, of approximately 12 - 48 hours, within which, if surgery is carried out during this timescale, then the outcome for the patient is likely to be much better.

However some experts believe that once urinary incontinence has begun, the chances of reversing the neurological damage becomes very slim.

What is clear is, the longer the delay in surgery, the less likely it is that a full recovery will take place and the more likely that you will be left with serious long term problems.

How do I know if I may have a compensation claim for Cauda Equina Syndrome?

CES is a spinal medical emergency, however doctors often don't consider CES as a diagnosis. As it is an uncommon condition, doctors frequently fail to detect the condition early enough, especially where all the symptoms are not present. If this has happened to you, then you may have a claim.

Many doctors send the patient home without  carrying out further investigations. Others, fail to advise the patient to return if the symptoms worsen or new symptoms develop. A failure to consider the diagnosis of CES if red flag symptoms are present, could be the basis for potential medical negligence if irreversible neurological damage occurs.

However, even if you have not developed any red flag symptoms at the time of the consultation with the doctor, then a medical negligence claim could potentially be brought on the basis that the doctor did not advise you to report back if you go on to develop any of these symptoms.

CES can also develop following spinal surgery. If this occurs and there is a delay in diagnosing or treating the CES, which then causes your injury to worsen, you may also have a claim for medical negligence.

Lastly CES can occur following a trauma, such as a fall from height or a road traffic accident. We have acted for clients who are involved in these accidents and who go on to develop CES. Sometimes, for one reason or another the CES is not picked up by doctors promptly, which causes our client’s injury to worsen. In other instances, if the CES results from a fall from height or road traffic accident which was not our client’s fault, then it is often possible to bring a claim for personal injury.

Raquel Siganporia heads up the Spinal Injury team at Bolt Burdon Kemp. 

If you or a loved one have suffered an injury as a result of someone elses negligence or you are concerned about the treatment you have received, contact us free of charge and in confidence on 020 7288 4844 or at for specialist legal advice. 

Alternatively, you can complete this form and one of the solicitors in the Spinal Injury team will contact you. You can find out more about the team here.

Raquel Siganporia
DDI +4420 7288 4844
Mobile: +447912 248985

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