Cauda Equina Syndrome
It is estimated only around 1 in every 33,000 people will suffer Cauda Equina Syndrome in their lives, making it a very rare condition. Nevertheless, it is one that medical professionals must have a thorough knowledge of, as if left untreated a patient will encounter serious complications.
What Is Cauda Equina Syndrome?
Cauda Equina Syndrome (CES) results from the compression of the nerves located at the bottom of the spinal cord (known as the 'cauda equina'). It may arise from a variety of causes, the most common being a prolapsed disc, while others include damage sustained during surgery or from a traumatic injury (such as a car crash). Some people may also be more prone to Cauda Equina Syndrome if they have a narrowed vertebral canal – known as 'spinal stenosis'.
If treatment is not given in a promptly fashion, the dysfunction of the nerve roots can cause a combination of long-term clinical features, such as: impairment of the bladder, bowel and sexual function, as well as perineal or 'saddle' numbness. These effects can be devastating for the patient, which is why it is vital for medical staff to be aware of the signs indicating Cauda Equina Syndrome.
Symptoms of Cauda Equina Syndrome
There are a number of 'red flag' symptoms that ought to alert doctors to the possible presence of CES. These include:-
- Bilateral sciatica;
- Urinary symptoms such as frequency, retention, altered urethral sensation, and the desire to void;
- Saddle anaesthesia;
- Buttock numbness;
- Altered perineal sensation;
- Impaired sexual function;
- Bowel disturbance such as constipation, faecal incontinence, and loss of awareness in passing stool or flatus.
During examination, medical professionals should look for physical findings such as:-
- Spinal tenderness;
- Loss of lumbar spine movements;
- Reduced straight leg raising;
- Loss of reflexes;
- Reduced or lost sensation in the perineal area;
- Loss of anal tone;
- Palpable bladder.
Treatment and Prognosis of Cauda Equina Syndrome
If there is a suspicion a patient is suffering from Cauda Equina Syndrome, there should be an urgent referral to a spinal surgeon with a view to investigation and, if necessary, surgery to decompress the nerves. This is particularly important where the condition remains incomplete (whereby the patient still has some function of their bowels and bladder), as the chance of successfully treating a patient is greatly improved. Conversely, those presenting with complete Cauda Equina may have already suffered irreparable nerve damage, something which can happen after as little as 6 hours.
Thus urgent surgery is needed both to preserve nerve function and to prevent any further impairment to bowel and bladder function. As such, the prognosis for complete recovery is not only dependent upon the severity of nerve compression, but also the duration of nerve compression. The longer the interval of time before treatment the greater the damage caused to the nerves, all of which makes the likelihood of a full recovery less and less probable.
Cauda Equina Syndrome and Medical Negligence
In the event a patient suffering from Cauda Equina Syndrome has sought medical assistance, but has then been wrongly diagnosed or not given urgent treatment, it is likely that long-lasting damage will occur. This can have a detrimental effect on a patient's life, causing both physical and emotional pain. If this has happened to you, you need to speak to a medical negligence solicitor. The delay in diagnosing Cauda Equina Syndrome is a common source of litigation, and you could receive compensation for the pain and suffering you have endured as a result of your medical team's negligence.
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