Cauda Equina Syndrome - A Cause for Concern

Cauda equina negligence is one of the most common causes of high value compensation claims against GPs. In recent years, many of the medical defence organisations, including the Medical Defence Union (MDU) and the Medical Protection Society (MPS), have warned doctors to make sure they recognise and react quickly to the red flag warning signs of cauda equina syndrome (CES).

Cauda equina is a medical emergency. Delays in referral for surgical treatment leave patients with permanent disability.

Cauda equina negligence remains a concern for the NHS and other professional indemnity organisations which insure GPs and hospital doctors against medical negligence claims. The MPS put CES negligence claims at the top of their expensive claims list in their 2017 report, The Rising Cost of Clinical Negligence: Who Pays The Price?

Whilst the cost of these claims often attracts the media’s attention, at Boyes Turner we never forget that each compensation payment reflects a devastating physical and often psychological injury to an individual. The emotional and financial impact of CES disability is usually suffered by the individual’s entire family.

What is cauda equina syndrome or CES?

Cauda equina syndrome is a medical emergency. The condition occurs when the bundle of nerve roots at the base of the spinal cord are squeezed or compressed. Compression of the cauda equina nerves can be caused by:

• slipped disc (disc herniation) in the lumbar spine (lower back);
• spinal fracture, injury or trauma;
• spinal tumour;
• spinal stenosis (narrowing);
• severe infection and inflammation.

What are the red flag warning signs of cauda equina?

Cauda equina has ‘red flag’ signs and symptoms which should be recognised as a warning or alarm bell, indicating the potential for serious injury. Doctors are expected to be aware of red flag warning signs and symptoms of cauda equina and other dangerous conditions. When a patient presents with red flag symptoms for CES the GP must react quickly to ensure that the patient is referred to a neurosurgical unit and receives urgent surgical decompression treatment.

Red flag symptoms and signs for cauda equina include:

• severe low back pain and/or sciatica (bilateral or unilateral) – often together with any of the following:
• pain on both sides radiating below the knee;
• bladder problems, such as changed sensation or difficulty urinating or incontinence (loss of control);
• bowel problems including incontinence (loss of anal sphincter control);
• muscle weakness or loss of feeling in both legs;
• lower limb weakness, numbness or difficulty walking;
• numbness on either side of the buttocks and ‘saddle’ area;
• sexual problems.

The type and severity of symptoms depend on the extent of the compression and which nerve roots are affected.

What is cauda equina negligence?

When the nerve roots below the base of the spinal cord are compressed, the patient needs an urgent MRI scan and emergency surgery to remove the pressure from the spinal cord. This is known as surgical decompression. Mistakes in diagnosis, delays in referral to hospital, delayed or incorrect surgical treatment can all result in devastating injury to the patient. Where a patient suffers serious avoidable injury as a result of these mistakes, they may be entitled to claim compensation for the disability that was caused by the cauda equina negligence.

Nearly all our clients’ cauda equina syndrome (CES) claims arise from GPs or (junior) A&E doctors mistaking the patient’s symptoms for more minor conditions, such as back pain.

When a patient complains of back pain the doctor must carefully examine and question the patient to find out the cause of the pain. Early symptoms of CES may be similar to other conditions. The doctor must check for red flag symptoms and signs of cauda equina because, although it is rare, it is dangerous. Early symptoms of cauda equina can very quickly lead to permanent disability.

If the patient has red flag symptoms for cauda equina, their GP should contact the neurosurgical or orthopaedic specialist at the hospital for immediate advice, or arrange for the patient to be admitted to hospital as an emergency.

Cauda equina negligence claims often arise when the patient’s GP or doctor:

• fails to listen to their description of their symptoms;
• fails to ask careful questions about the patient’s symptoms;
• fails to examine the patient properly;
• fails to identify or rule out “red flag” warning symptoms of cauda equina;
• incorrectly diagnoses back pain without checking for signs and symptoms of cauda equina;
• fails to arrange urgent surgical review/treatment for a patient with cauda equina red flag symptoms;
• fails to advise a patient with back pain to call for urgent medical help if they develop cauda equina symptoms.

CES negligence claims can also arise against a hospital when avoidable disability was caused by:

• negligent cauda equina decompression surgery;
• failure to diagnose and treat post-operative complications.

Doctors are expected to make a note in the patient’s medical records of their examination of the patient and the steps they have taken to rule out, warn the patient, diagnose or arrange treatment of this serious condition.

How does cauda equina negligence lead to disability from CES?

The cauda equina nerves give movement and sensation (feeling) to the legs and the bladder. When these nerves are compressed, they can’t perform their function. If the nerve root compression is not released urgently, it can cause permanent bladder and bowel problems and paralysis to the muscles of the legs. Even short delays can lead to permanent loss of function and disability.

Boyes Turner’s CES negligence lawyers help clients claim compensation after cauda equina negligence

Our spinal injury lawyers have over 30 years’ experience of winning cauda equina syndrome claims. We understand cauda equina and are skilled in recognising cauda equina negligence. We have helped CES clients recover substantial compensation after cauda equina GP and hospital negligence has led to:

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

Depending on the client’s own injury and circumstances, they may be entitled to claim compensation for:

• the CES injury, pain, disability and loss of function;
• loss of earnings, if their ability to work has been affected;
• necessary home adaptations to improve accessibility, facilities, or provide space for carers or specialist equipment;
• specialist equipment, such as wheelchairs and adapted vehicles;
• the cost of therapies, such as physiotherapy, occupational therapy (OT);
• care and home help costs;
• psychological counselling.

Our recent cauda equina compensation settlements include:

• £800,000 for a 40-year-old man left with bowel and bladder damage, impaired mobility and sexual dysfunction; 
• £400,000 for a woman with urinary and faecal(bowel) incontinence, permanent loss of sexual sensation, altered sensation in the saddle area and psychological injury;
• £275,000 for a man in his thirties left with fatigue, permanent pain and leg weakness, impaired urinary, bowel and sexual function.

If you have suffered severe injury from negligent medical treatment of cauda equina, you can contact one of our experienced cauda equina lawyers to find out more about making a claim by emailing mednegclaims@boyesturner.com.