Cauda Equina Syndrome Referrals

At what point should a competent medical practitioner refer a suspected cauda equina syndrome patient for an emergency MRI?

Symptoms of cauda equina syndrome

The symptoms of cauda equina syndrome can be both wide-ranging and varying in the severity and the pace with which they develop, with patients experiencing either a gradual or a sudden onset of the condition.

As the cauda equina nerves become compressed in the lumbar region of the back, the patient is likely to start to experience some of the following symptoms:

• Urinary dysfunction/alteration
• Bilateral leg pain, numbness
• Bilateral weakness in the legs
• Numbness of the ‘saddle’ region
• Bowel dysfunction
• Sexual dysfunction

A key question, therefore, is at what point is it appropriate for a patient exhibiting any of these symptoms to be referred for what could be an absolutely crucial MRI scan?

Urinary function as a trigger for investigation

The degree of urinary function – or loss of – is widely regarded as a key factor in determining the need for an emergency MRI – and emergency surgery – in patients with suspected cauda equina syndrome.

Where the patient has started to experience an alteration in their urinary function such as a poor flow or having to strain when urinating, alongside other red flag symptoms, a medical practitioner should consider the possibility of a cauda equina syndrome diagnosis.

An emergency MRI is considered to be necessary at this point in order to facilitate emergency decompression surgery should the MRI confirm the diagnosis. Where this does not occur, the patient’s symptoms may deteriorate to the point where surgery is likely to be less successful. This is an outcome which can frequently lead to lifelong symptoms for the unfortunate patient and long legal battles over compensation.

Symptoms in the legs

However, research suggests that, whilst alterations in urinary function are often telling red flag symptoms of cauda equina syndrome, alterations to sensation and function in the legs may signal the onset of the condition and should, therefore, merit closer attention and investigation.

Especially where the syndrome develops gradually over time, the patient frequently visits the GP with symptoms in the legs. This may commence as pain and numbness in one leg, but where these sensations start to affect both legs, along with alterations in motor function in the legs, and perhaps with some loss of sensation between the legs, the patient may well be heading towards a cauda equina syndrome diagnosis.

Would a referral for an MRI be appropriate at this stage?

Given the prospect of partial paralysis and double incontinence if surgery is delayed, most patients would probably prefer to undergo an MRI that proves to be unnecessary rather than face a lifetime of lower body dysfunction.

Medical Negligence

The British Association of Spine Surgeons urges adopting ‘a low threshold for investigation with an EMERGENCY scan.’

Where key symptoms of cauda equina symptom have been ignored or misdiagnosed, the medical practitioner in question could be guilty of providing substandard medical care.

Contact Glynns Solicitors if this has been your experience and you are continuing to suffer the long-term effects.

We are specialists in medical negligence, with considerable experience of cauda equina syndrome claims and would be happy to offer you advice as to the best way forward.

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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