Recognising Cauda Equina Syndrome

Although damage to the cauda equina may be caused in a variety of ways, the term cauda equina (CES) has come to be applied specifically to the neurological dysfunction that follows massive central disc prolapse. This is rare, accounting for only about 2% of lumbar disc operations. This most common level is lumbar 4/5.

Signs cauda equina syndrome

Cauda equina syndrome is characterised by:

• Severe low back pain
• Sciatica (in one or both legs)
• Saddle and genital sensory deficit
• Bladder, bowel and/or sexual dysfunction

Wither complete cauda equina syndrome the main consequence is loss of bladder control. When the bladder and sphincters are denervated there is a lack of awareness of the need to void and either straining or manual pressure is needed to micturate. A typical picture is of dribbling, overflow and urinary incontinence. Sensation in the genitalia is lost, as is anorectal incontinence, something which often leads to constipation.

Detecting cauda equina syndrome

Any reasonable medical professional should be able to recognise the signs of cauda equina syndrome and appreciate the need to order further investigations. This would apply to any patient with a history of overflow incontinence of urine, a lack of any discomfort or warning signs that the bladder was full, faecal incontinence with lack of sensation of desire to have the bowels open. There would also usually be severe leg pain, either in one of both legs, with other neurological symptoms such as numbness or weakness of the knee of ankle muscles. Occasionally patients might also have noticed some numbness around the perineum.

If a patient is complaining of these symptoms, doctors should waste no time in performing a physical examination. A doctor should test sensation around the perineum, rectal tone, whether there is limitation of straight leg raise, absence of power in the foot, and absence of reflexes at either the knee of the ankle. If the physical examination does reveal these problems, and a patient has bladder and bowel symptoms, an urgent MRI scan should be performed.

Delayed diagnosis of cauda equina syndrome

Sciatica and limitation of straight leg raise will not in themselves indicate the need for urgent scanning. But when presented in conjunction with bladder signs (the main symptom suggesting cauda equina syndrome) a patient will require further investigations and/or surgery.

If medical professionals fail to diagnose cauda equina syndrome in a timely fashion because they have not recognised the characteristic symptoms of nerve compression, there will be grounds for a medical negligence claim.

To find out more about claiming for cauda equina syndrome, contact us today at the Cauda Equina Solicitors.

Please call us free on 0800 234 3300, from a mobile click to call 01275 334030 or complete our Free Online Enquiry for a no cost, no obligation opinion.

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