One of the UK’s leading medical defence organisations, the Medical Defence Union (MDU), which represents and indemnifies doctors, has warned GPs about the importance of prompt diagnosis of cauda equina syndrome (CES). Even short delays in recognising the red flag symptoms of this serious, neurological condition can result in permanent disability. Since 2005 the MDU has paid out £8 million on behalf of doctors as compensation to patients disabled by undiagnosed CES.
Cauda equina syndrome occurs when the nerve roots below the termination of the spinal cord are compressed. Common causes of nerve root compression are disc prolapse (slipped disc), physical trauma to the area, tumour, infection and inflammation. In its early stages the condition can be difficult to diagnose, particularly if the patient’s main complaint is lower back pain. However, careful listening and direct questioning about other related symptoms should reveal symptoms and signs which differentiate this medical emergency from other less dangerous conditions. When a diagnosis of cauda equina is suspected the patient must be referred to hospital urgently so that surgical decompression can take place before the patient suffers permanent loss of function.
In their warning, the MDU gave advice to GPs on ways to avoid delays in diagnosis of cauda equina syndrome. GPs were reminded to:
- Carry out a full examination of the patient to establish the cause of their back pain and record the examination in the medical notes
Consider red flag symptoms:
- Pain radiating below the knee bilaterally (on both sides)
- Lower limb numbness or weakness
- Numbness on either side of the buttocks and saddle area
- Disturbance of bowel function
- Disturbance of bladder function, such as difficulty passing urine, poor stream or loss of sensation
- Erectile dysfunction
- Loss of anal tone or impaired sensation on rectal examination
- If red flag symptoms are found, the GP should call the hospital orthopaedic or neurosurgical specialist for immediate advice. In their absence, they should arrange for the patient’s admission to hospital via the emergency department
- Patients with back pain should be given ‘safety netting’ advice, including warning the patient of CES symptoms to look out for and the importance of seeking urgent medical help if these symptoms should appear
- GPs should make a record in the medical notes to show that they have considered cauda equina syndrome and have given appropriate advice
Delay in diagnosis or failure to arrange emergency surgical treatment can result in the patient suffering permanent disability.
At Boyes Turner, our experienced and specialist medical negligence lawyers have secured compensation awards for clients with cauda equina syndrome. Despite presenting to their doctors with red flag symptoms their CES diagnosis and treatment was delayed. As a result they now have:
With GPs under increasingly greater pressure we welcome the MDU’s timely reminder that cauda equina is a medical emergency requiring prompt diagnosis and urgent hospital referral.