Developing Cauda Equina Syndrome
Cauda equina syndrome is a life-changing condition but, if treated promptly at the right moment, patients can make a good recovery. Recognising when an urgent referral is necessary is key to this outcome.
Not all patients will develop cauda equina syndrome in the same way. Their initial symptoms and their severity may vary, as will the speed with which symptoms worsen. However, there are a range of symptoms that are likely to be common and key thresholds which should influence how quickly medical practitioners respond to the patient's symptoms.
Early possible warning signs and symptoms
Patients who attend their GP with some or all of the following symptoms are not necessarily going to develop cauda equina syndrome but the GP should ensure that they undergo urgent investigation with an MRI and warn the patient of the symptoms which should prompt them to attend A&E as a matter of emergency.
- Pain spreading from the lower back down through the legs
- Altered sensation down both legs
- Weakness affecting both legs
- Loss of some reflexes in the legs, perhaps at the ankle
Although these patients do not necessarily have cauda equina syndrome, the above symptoms are of considerable concern, and, if an MRI suggests that the patient is experiencing compression of the cauda equina nerve roots at the base of the spinal cord, urgent surgery will be necessary to prevent further deterioration. Such action may well mean that the patient will recover all feeling and function.
Emergency cauda equina syndrome alert
A significant warning sign that a patient is developing cauda equina syndrome and may require emergency surgery within hours, is the deterioration of the patient's urinary sensation and/or function.
If the patient starts to lose the awareness of needing to urinate or difficulty in doing so, they require an emergency response. The likelihood is that, if diagnosis and surgical treatment of the patient is delayed beyond the next few hours, they may risk losing control of that function completely.
Additional or alternative signs that the patient is developing cauda equina syndrome are loss of sensation around the anus and buttocks and impaired sensation around the genital area.
Complete cauda equina syndrome
If the patient is no longer aware that they need to urinate, possibly leading to urinary incontinence, they are considered to have complete cauda equina syndrome (also known as CES with retention). The patient may also have lost bowel control and sexual function.
The outcome of surgery at this point is less favourable. Some patients recover a degree of function and sensation after surgery and some do not. Nonetheless, prompt diagnosis and surgery – within 48 hours - is still desirable as the sooner the nerves are decompressed, the better the chances of a good outcome.
Responding to cauda equina syndrome
Cauda equina syndrome is rare but these red flag symptoms are sufficiently clear to alert the medical practitioner to the need for urgent or emergency action.
Where the patient is experiencing lesser symptoms, such as lower back pain or pain and weakness in one leg, it does not mean that they will not develop cauda equina syndrome, but there is less justification for an urgent response and monitoring of signs and symptoms may be more appropriate.
Was your cauda equina syndrome treatment delayed?
If you presented to your GP or A&E with key symptoms of developing cauda equina syndrome but you were not referred urgently for investigation, leaving you with a poor long-term outcome, you may be able to claim for compensation.
Glynns Solicitors have years of experience of supporting high-value, successful cauda equina syndrome claims. Contact us to discuss your circumstances with a specialist medical negligence solicitor.
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