Cauda Equina Compression from Post-Operative Haematoma
It is possible for the cauda equina nerves to become compressed by a haematoma after a surgical operation. It is important the complication is recognised and treated quickly, or the nerves could sustain serious damage.
Nerve compression from haematoma
A haematoma is the medical term for a blood clot. A spinal epidural haematoma is a recognised risk of spinal surgery, particularly operations such as laminectomies. The vast majority of post-surgical epidural haematomas occur within a few hours of surgery.
Most haematomas are not problematic. However, some will press directly upon the cauda equina nerves, which are located at the bottom of the spine. When this happens, the patient will develop neurological symptoms.
If a patient has had an epidural, neurological issues may not become immediately apparent because the anaesthetic is masking the symptoms. When they do arise, symptoms can include numbness in the legs and buttocks, urinary retention (i.e. being unable to urinate properly) and leg weakness.
These neurological handicaps should be picked up immediately. Doctors should be alerted to the patient's deteriorating neurological picture and an emergency MRI scan arranged. An MRI scan will show whether there is anything, such as a haematoma, compressing the nerves.
Treating spinal epidural haematoma
If a spinal epidural haematoma is present and is causing nerve compression, the patient should be returned to theatre the same day of the primary surgery. If this is achieved, decompression is usually met with a favourable outcome.
It is important that clinicians act with urgency because there is only a small window of opportunity in which to successfully treat nerve compression. This is because the nerves are very delicate and compression from a haematoma will soon result in permanent nerve damage.
When the cauda equina nerves are permanently damage, the patient will be left with chronic cauda equina syndrome. This is a life-changing condition associated with immobility, incontinence and sexual dysfunction.
The only way to avoid the onset of a permanent cauda equina syndrome is to diagnose and remove the haematoma quickly, before permanent nerve damage occurs.
Failure to treat haematoma
A spinal epidural haematoma is rare. Nevertheless, when a patient's neurological status deteriorates after spinal surgery, a haematoma should be immediately suspected. An MRI scan will confirm a diagnosis, after which a patient should proceed straight to theatre.
If this standard of care is not met, causing a patient to suffer serious injury, there could be grounds for a compensation claim. Contact us to find out more.
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