Confirming a Diagnosis of Cauda Equina Syndrome

Even if a patient is displaying the characteristic signs of cauda equina syndrome, a diagnosis can only be confirmed with an MRI scan.

Clinical signs of cauda equina syndrome

Cauda equina syndrome is when neurological dysfunction occurs due to spinal nerve damage. More specifically, it happens when the nerves located at the base of the spine – called the cauda equina – sustain some form of compression. This might be compression due to a spinal tumour, a slipped disc or an inflammatory condition.

There are various ways in which the nerves can be compressed. However compression occurs, the effect will be the same: the nerves will be crushed and damaged. Once the nerves are harmed their function will be greatly reduced.

When the cauda equina nerves lose function because of compression, the individual in question will begin to notice certain neurological problems. These symptoms will worsen the longer compression continues. The clinical signs of cauda equina syndrome are:

• Lower back pain
• Sciatica in one or both legs
• Perineal/buttock/leg/genital numbness
• Bladder dysfunction

MRI scan for cauda equina syndrome

A patient who seeks medical help for these symptoms should undergo a full neurological examination for suspected cauda equina syndrome. A neurological examination is intended to test the level of sensation in saddle area, the amount of rectal tone, lower limb reflexes and the patient’s ability to perform a straight leg raise.

If the clinical symptoms and neurological examination both indicate cauda equina syndrome, no time should be wasted in confirming whether or not this suspected diagnosis is accurate. The only way to verify a diagnosis is to perform an MRI scan.

MRI scans are deemed to be the gold standard when diagnosing spinal conditions. Other imaging tests are not as effective. For example, the images produced by a CT scan can be obstructed while x-rays can be insensitive, making it easy for medical practitioners to miss things.

When doctors have obtained radiological confirmation that a patient has cauda equina syndrome, the patient should be sent to theatre for emergency decompression.

Delayed MRI scan for cauda equina syndrome

Unfortunately a patient with the clinical signs of cauda equina syndrome is not always sent for an emergency MRI scan. This might occur because doctors do not consider a diagnosis of cauda equina syndrome. Or it might occur because of difficulties in securing an MRI scan. They are not routinely available on an acute basis, and there can be reluctance amongst radiologists to conduct emergency MRI scans on possible cauda equina patients because there is a high false positive rate.

Nevertheless, a failure to send a patient for an emergency MRI scan can be devastating for a patient who does indeed have spinal nerve compression. If this causes a patient to suffer injuries that could have been avoided with an earlier diagnosis, there may be grounds for a claim. Contact us today for more information.

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