Medical Negligence

What is cauda equina syndrome?

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6 min read time

Back pain can be concerning, especially when the cause is unclear. Cauda equina is a little-known syndrome that has dire consequences when left untreated.

In this article, we discuss the causes and symptoms of cauda equina syndrome as well as its treatment and long term effects. We will also discuss the circumstances in which you could have a cauda equina syndrome compensation claim.

What is Cauda Equina Syndrome?

“Cauda equina” translates to “horse’s tail” in Latin, and describes the nerves emanating in the lumbar region from the spinal cord which activate the lower organs and muscles. “lumbar” simply means in the lower back.

In simple terms, cauda equina syndrome (CES) is the dysfunction of these nerves supplying the bladder, bowel, genitals, legs, and saddle area. Your “saddle area” is where contact would be made if you were riding a bike.

CES happens when the collection of the nerves at the bottom of the spinal cord become compressed, resulting in numbness, pain, and potentially disastrous long term effects.

How Rare is Cauda Equina Syndrome?

Cauda equina syndrome is incredibly rare, but it is also a very serious condition that must be diagnosed and treated quickly.

It is believed to affect one to three people, per 100,000. Approximately two people in every 100 that have herniated lumbar discs may develop CES.

What Causes Cauda Equina Syndrome?

The most common cause of CES is usually a large central disc prolapse in the lower spine. Other much rarer causes of CES include tumours, infection, trauma, or haematomas.

CES is an emergency because there is the possibility that timely surgery can salvage the function of the nerves supplying the bladder, bowel, genitals, legs, and saddle area. Where treatment is delayed, functioning is often permanently lost.

What are Symptoms or Signs of Cauda Equina Syndrome?

There are a group of symptoms or signs, known as ‘red flags’ for CES, whereby the diagnosis should be suspected if they are present. Knowing these early symptoms of CES means that treatment can be administered swiftly, helping to prevent severe long term implications.

Usually, severe low back pain or sciatica is present as the main symptom. However, very rarely, CES can occur in the absence of either. The other main symptoms of CES include:

  •       Sciatica affecting both legs
  •       Altered function of both legs
  •       Reduced sensation in the saddle, peri-anal, genital region, or urethra
  •       Reduced or complete loss of bladder control and bowel function
  •       Altered sexual function

Typical bowel symptoms in CES are constipation, reduced sensation, and difficulties with bowel emptying.

The progression of CES differs. In some patients, it can occur within a few hours, while in other patients’ progress slowly over days or weeks.

Cauda Equina Syndrome Treatment

CES is an emergency therefore urgent medical assistance should be sought. Patients with a new diagnosis of CES should be treated as soon as possible, and there is a risk that delay could result in a worse outcome.

Since persistent cauda equina compression causes a worse outcome, reports of the red flag features should result in an emergency referral to A&E, for example, when a patient complains to their GP. Once in attendance at the hospital, an emergency MRI scan and surgical decompression are mandatory within 24 hours.

The syndrome almost always requires surgical decompression to reduce and eliminate pressure on impacted nerves. Lumbar decompression surgery is usually performed using laminectomy, where a section of bone is removed to relieve vertebrae. Depending on your symptoms and individual circumstances, lumbar microdiscectomy is sometimes recommended. This is where a section of the damaged disc is removed to alleviate pressure on the nerve.

Lumbar decompression is performed under general anaesthetic, meaning you will be unconscious during the procedure. The operation takes at least one hour but may take longer depending on the complexity of the procedure at hand.

Cauda Equina Syndrome Recovery

The patient’s outcome normally depends on the timing of the surgery, as the earlier the surgery is performed the better the outcome will be.

Decompression surgery should be carried out ideally within the first 24 hours after the onset of symptoms. After 48 hours, chances of normal functioning returning reduce. Any more than that, you, will usually face long term effects of CES such as pain, bladder dysfunction, and sexual dysfunction.

Surgery helps to preserve function and sensation left behind after the nerves have been damaged. Recovery from decompression surgery will vary depending on your fitness level before the operation, however, it usually takes between 4 to 6 weeks to reach your expected level of mobility and function. How much mobility and function you regain will depend on the severity of the condition and the symptoms experienced.

Cauda Equina Syndrome Claims

If you believe that you have suffered from medical negligence in relation to CES, then you may have a Cauda Equina claim.

We have seen many examples of Cauda Equina Negligence claims for suffering that could have been avoided. If you have sought advice for your symptoms but a diagnosis was not made, then you may have a claim for medical misdiagnosis. Similarly, if surgery was not considered urgent and the best opportunities to treat you at an early stage have been missed, you could claim medical negligence.

In the unfortunate cases where something goes wrong while going through surgery, you may have a claim for surgical errors resulting in worse damage and untreated symptoms.

Even if the surgery goes well, some people suffer from further damage because of poor recovery. Medical errors, delays, and oversights from GPs and hospitals can all result in life-changing consequences.

Cauda Equina Syndrome Compensation

If you make a successful medical negligence claim for CES, you are entitled to receive compensation for the pain you have suffered.

Compensation amounts for CES vary depending on the individual circumstances of your case. Factors that affect the damages awarded include whether:

  •       Any psychological injury suffered
  •       Private treatments or surgeries are required
  •       Adaptations to the home and medical equipment are needed for day to day living
  •       There is a loss of current or future earnings
  •       There are ongoing medical costs relating to CES

The exact figure you are entitled to will vary between patients, however, this can greatly exceed £500,000 in some cases.

Cauda Equina Syndrome Specialists

Whatever you decide to do, our award-winning medical negligence team is here for you every step of the way. If you wish to make a claim for CES, get in touch using our online claim form. Our experienced solicitors will arrange a free, confidential, no-obligation chat to discuss your circumstances and assess how much you may be owed.

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What is cauda equina syndrome?

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