Does Cauda Equina Syndrome Need a Higher Profile?
Cauda Equina Syndrome can produce permanent, appalling, life-changing symptoms. The best approach to treatment is widely agreed. So, why does the condition go undiagnosed?
What's the problem?
A review of cauda equina syndrome by Alan Gardner, Edward Gardner and Tim Morley observed a 'lack of awareness and urgency in the management (of the condition) by all concerned'.
This may not seem surprising when it is considered that as few as 1 in 100,000 people in the UK may experience the condition.
However, at the same time, it is necessary to consider the following:
- 1) In the years 2003 and 2008, the NHS Litigation Authority was advised of 78 cauda equina syndrome claims against the service, resulting in a total compensation pay-out to patients of over £2.5 million after the settlement of only 24 cases.
- 2) The long-term effects of cauda equina syndrome, where diagnosis and treatment are delayed can include double incontinence and partial paralysis.
- 3) It is widely accepted that urgent diagnosis is vital to ensure emergency surgery is undertaken where necessary.
- 4) It is also recognised that, if surgery takes place within 48 hours, the worst of the possible outcomes may be avoided.
The report commented that 'the GP or therapist may not have appreciated the gravity of the situation' and 'junior doctors and nurses not recognising the syndrome' could lead to misdiagnosis or delayed diagnosis. The rarity of CES may be its greatest enemy.
Misdiagnosis
When a patient presents with lower back pain and leg weakness and pain, even where they are also experiencing tingling in the 'saddle' area between the legs, their GP or A&E medical practitioner may be more likely to diagnose sciatica and provide pain relief, rather than consider the possibility that they may, in fact, be developing cauda equina syndrome. They may not be referred for an MRI scan, which should otherwise identify compression of the cauda equina nerves in the lumbar spine.
Even where an MRI referral is given, the facilities to carry out the scan are not always readily available, especially in an out-of-hours situation.
Why does the timing matter?
The issue of timing is key to the outcome for the patient suffering cauda equina syndrome. If the patient has 'incomplete' CES (CES-I) and still retains some control over their urinary function, research suggests that they have a good chance of recovering after surgery where it is carried out within 48 hours of the onset of symptoms.
If the delay in diagnosis and treatment means that the patient deteriorates to 'complete' CES (CES-R) with lack of control of urinary function, their chances of recovery are significantly lower. To quote the report, 'it is a tragedy and usually preventable that CES-I is allowed to progress to CES-R while under medical supervision.'
Medical Negligence
When the stakes are so high for the long-term well-being of the patient, it is vital that the red flag symptoms of cauda equina syndrome are widely and accurately understood and that systems are in place to allow for the smooth, rapid and effective processing of the patient.
The report recommends that A&E departments should have 'a CES protocol' to facilitate this. Where delays occur to the detriment of the patient, it may be suitable to claim compensation for long-term debilitating effects.
Speak to a solicitor
Contact Glynns Solicitors, specialists in clinical negligence with considerable experience in cauda equina syndrome cases.
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