Acting Upon The Red Flag Symptoms of Cauda Equina Syndrome

Medical professionals must recognise the red flag symptoms of cauda equina syndrome and act immediately, referring a patient for surgery on an emergency basis.

Red flag symptoms

The red flag symptoms of cauda equina syndrome are:

• Chronic back/leg pain
• Urinary disturbances
• Numbness in the perineum, buttocks and genitals

Acting on the red flag symptoms of spine compression

These symptoms represent red flag symptoms and should prompt a detailed examination of sacral nerves.

Likewise, from a physiotherapy or general medical point of view, when a patient presents with bilateral leg numbness and bilateral restriction in straight leg raising, with likely discogenic back pain and sciatica, this represents red flag signs. This should prompt a very detailed enquiry about bladder and bowel function and also perineal sensory loss. It should also prompt a very clear forewarning of any sinister urinary or bowel disturbances.

A patient with the symptoms of cauda equina syndrome with urinary incontinence represents a surgical emergency. A referral must be made for emergency decompression surgery that day. Nothing should detract from the emergency of the situation. If the orthopaedic or neurosurgeons cannot operate for any reason, a patient should be referred to the emergency surgeons.

Offering an operation at a later date – for example, in one week’s time – would represent substandard treatment of a patient with emergency red flag symptoms of cauda equina syndrome.

Success of decompression surgery

The success of decompression surgery directly correlates to the type of urinary incontinence a patient is suffering.

If a patient has painless retention of urine with overflow incontinence – a situation which defines complete cauda equina syndrome – then on the balance of probabilities the chances of a positive response to the surgery will be diluted below the 50% probability. Symptoms typical of a post-cauda equina syndrome include exacerbations of leg and back pain, persisting urinary incontinence (particularly of a stress type) and no warning of bladder fullness.

If a patient has not been incontinent of urine, this represents an early stage of an incomplete cauda equina syndrome. There may be some urge incontinence indicating some irritability of the bladder and possibly some sacral nerve disturbance. If surgery is carried out prior to the condition becoming complete then, on the balance of probabilities, a patient’s outcome will be very good with decompression surgery.

Failure to act on red flag warnings

If medical practitioners fail to heed the warning signs of cauda equina syndrome, delaying decompression surgery, there may be a case of medical negligence. Contact us to find out more.

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