Cauda equina syndrome claims

Cauda equina syndrome (CES) is a rare but serious neurological condition caused by compression of the nerves in the spinal column. ‘Cauda equina’ is Latin for ‘horse’s tail’ and describes how the cauda equina nerve roots at the base of the spinal cord emerge from the holes between the vertebrae (bones in the spine) and fan out into a bundle of fibres - like a horse’s tail.

The cauda equina nerves control the legs and feet and give sensation and control to the bladder, bowel, anal and genital areas. Cauda equina syndrome or CES occurs when these nerve roots are compressed, such as by a slipped disc, inflammation or physical trauma.

Compression of the cauda equina nerves is a medical emergency. Patients who are experiencing CES symptoms require urgent decompression surgery to relieve the pressure on the cauda equina nerves. Delays in diagnosis, referral for neurosurgical review and MRI scan, or surgery can result in permanent and devastating disability from cauda equina syndrome.

Cauda equina syndrome or CES is caused by compression of the cauda equina nerves at the base of the spine. The cauda equina nerve root compression can be caused by:

• slipped disc (disc prolapse);
• physical trauma or injury to the lower back area;
• tumours;
• infection and inflammation;
• complications from spinal surgery;
• conditions affecting the spine, such as spina bifida or spinal stenosis (narrowing).

If the warning or ‘red flag’ signs of cauda equina syndrome are recognised and the pressure is relieved quickly by urgent surgery, the nerves should recover without causing permanent disability.

Symptoms of cauda equina syndrome or CES are sometimes known as ‘red flags’ and may include one or more of the following:

• lower back pain;
• radiating pain;
• numbness, weakness or pain in the legs;
• loss of sensation in the buttock and perineal region;
• reduced anal tone;
• sexual dysfunction or loss of sensation;
• bladder dysfunction, such as difficulty passing urine, poor stream or loss of sensation.

Cauda equina syndrome can be difficult to diagnose because some symptoms may not be present, or may be experienced in varying degrees and over different timescales.

Cauda equina syndrome is a rare condition, but it is also one of the most common types of negligence claims against GPs. Doctors must be alert to red flag symptoms and act quickly to ensure patients with suspected CES receive urgent MRI scans, specialist neurosurgical review and surgical treatment.

Mistakes and delays at any stage in the patient’s treatment along the  ‘CES pathway’ can result in permanent disability and loss of function. CES compensation claims often involve negligent delay or failure by GPs, but can arise from negligent care by the ambulance service, or hospital radiologists, neurosurgeons or doctors in accident and emergency departments (A&E).

Common delay errors which lead to CES disability and medical negligence claims include delays in:

• recognising CES red flag warning signs and symptoms;
• referring the patient to a neurosurgical or orthopaedic specialist for advice;
• referring or transferring the patient to the hospital as an emergency;
• carrying out an MRI scan;
• performing emergency surgical decompression to relieve the pressure on the nerves.

Common GP errors which lead to CES disability and medical negligence claims include:

• failing to listen to the patient’s description of their symptoms;
• failing to question the patient carefully about their symptoms;
• failing to examine the patient properly;
• failing to identify or rule out “red flag” symptoms of cauda equina syndrome;
• misdiagnosing backpain without checking for CES symptoms;
• failing to arrange urgent neurosurgical review and treatment for a patient with CES red flag symptoms;
• failing to provide safety-netting advice to a patient with back pain about the importance of seeking urgent medical help if they develop CES symptoms.

Common hospital errors which lead to CES disability and medical negligence claims include:

• delays in neurosurgical review, MRI scans and decompression surgery;
• misinterpretation of MRI scans;
• negligent cauda equina decompression surgery;
• failure to recognise and treat post-operative complications.

Cauda equina syndrome claims can also arising from disability caused by NHS system errors, such as out-of-hours shortages of available MRI scanning facilities or staff, such as neurosurgeons and radiologists.

Cauda equina syndrome can affect any of the lower body functions that are controlled or given sensation by the cauda equina nerves. This means that many people with CES find that it affects their bowel, bladder and sexual function, physical sensation around the genital, perineal and anal region, as well as strength and movement of the lower limbs.

We have recovered substantial compensation for clients whose CES treatment was negligently delayed, leading to permanent disability, including:

• impaired mobility;
• paralysis;
• pain and numbness;
• impaired bowel and bladder function and incontinence;
• sexual dysfunction;
• psychological injury.

Each client’s CES compensation settlement is carefully valued to reflect their individual injury and the needs that arise from their disability.  We work closely with our clients and a team of trusted experts to understand the impact that the injury has had on our client’s life.

Most of our clients find that their CES disability reduces their independence and ability to carry out daily activities at home and at work. Whilst compensation cannot undo the injury, it can pay for solutions and support to ease the day-to-day difficulties faced by people who have been injured by CES. A successful claim can also replace lost income, providing the  financial security and peace of mind that comes with knowing that their ongoing needs will be met.

Our cauda equina syndrome solicitors have helped clients with CES recover compensation including:

• pain, suffering and disability;
• loss of earnings and pension;
• care and home help;
• therapies, such as physiotherapy, occupational therapy;
• specialist equipment, such as wheelchairs and adapted vehicles;
• home adaptations, to improve accessibility, accommodate carers or specialist equipment;
• private medical costs;
• psychological counselling.