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Written on 9th May 2022 by Julie Marsh

This Spinal Cord Injury Awareness Day we are supporting Spinal Injuries Association (SIA) and partner charities Aspire, Back Up and Spinal Research in raising awareness about spinal cord injury (SCI).

One of the lesser known causes of SCI is a rare condition called cauda equina syndrome or CES. Unlike sudden, traumatic injury which severs the spinal cord as a result of an accident or fall, CES is caused by compression of the nerves at the base of the spine and often has a more gradual progression. In the short period of time between the onset of symptoms and irreversible SCI, the condition can be reversed by surgical treatment. Cauda equina syndrome is a medical emergencyDelays in diagnosis or treatment of CES can cause life-changing disability.

We asked cauda equina syndrome claims specialist, Julie Marsh, to tell us more about CES and how it affects those who live with it.

Julie, you’ve worked with people with cauda equina syndrome from medical negligence for over 10 years now. Had you heard of cauda equina syndrome before you joined Boyes Turner’s clinical negligence team?

No, I hadn’t. At that stage of my career I had worked as a personal injury paralegal, so I knew that severe spinal cord injury could be caused by a road traffic accident (RTA) or other traumatic injury. Until I joined the medical negligence team and started working on cauda equina syndrome cases, I was unaware that such a debilitating injury, with such long-term consequences, could result from a disc moving out of alignment and compressing the spinal cord.

What made you take a specialist interest in CES and help people who have suffered avoidable harm from negligent management of cauda equina syndrome?

One of the first medical negligence cases that I was involved in related to a delay in diagnosis and treatment of CES in a young man. Liability had been admitted by the time I was asked to assist on the case, so I was working on understanding the full effects of his injury to ensure that we recovered the right amount of compensation.  Negligent treatment of his CES had left him with significant mobility problems but he had managed to return to work.  He was determined to continue living his life to the fullest. This included completing his family.  He had been left with sexual dysfunction after his CES, so the costs of fertility treatment were included in the claim.  Seeing the challenges that this client faced in every area of his life really opened my eyes to the impact that a spinal cord injury can have.

How serious is cauda equina syndrome?

CES is a medical emergency, because any delay in relieving the pressure on the nerves at the base of the spine can result in serious, irreversible injuries.  There is national guidance which sets out the ‘red flag’ symptoms and signs of CES, and there have also been numerous attempts to raise awareness about the dangers of delayed treatment of CES.  Despite this, I still see many cases where patients with red flag symptoms and signs have been sent home incorrectly by GPs or hospitals, or emergency surgery has not taken place because MRI scans have been misinterpreted.

Is cauda equina syndrome avoidable?

With correct, timely treatment, most people with symptoms of CES should avoid permanent disability from cauda equina syndrome. NHS problems, such as lack of access to GPs, A&E overcrowding and ambulance delays, and shortages of staff or scanning resources, do not alter the fact that suspected CES must always be treated as a medical emergency.

In the cases that I see, the problem is often a lack of awareness amongst GPs or other healthcare staff about the importance and urgency of referral for scans and specialist neurosurgical treatment. It’s really sad to see people suffering from disability which should have been totally avoidable if their doctor had recognised potential signs of CES and taken correct steps to investigate further and refer them for urgent scans and specialist treatment.

A common feature of many of your clients with CES is that their early symptoms were ignored. How does CES develop? Are there symptoms and signs of cauda equina that should be never be ignored?

CES occurs when a disc slips out (or prolapses) from between the bones of the spine or moves out of alignment.  This results in a narrowing of the spinal canal and puts pressure on the nerves that control bladder, bowel and sexual function. It can cause significant lower back pain and pain that radiates down one or both legs which in turn can cause mobility issues.

Whenever a doctor sees a patient who has lower back pain with sciatica, they should consider whether the patient has CES. They should ask the patient questions to determine whether they have red flag signs for CES, including detailed questioning about changes in the patient’s ability to pass urine or bowel movements, and any changes in sensation (such as numbness) associated with both (including wiping etc).

What should happen when people see a doctor with potential symptoms or red flag signs of cauda equina?

CES is a clinical diagnosis. It needs radiological confirmation. This means that anyone with suspected CES should be referred to hospital immediately and have an urgent MRI scan. If CES is confirmed on the scan, the patient needs emergency surgery to decompress the spine.

Why is it so important to obtain treatment without delay?  

Delay in treatment extends the time period during which there is pressure on the cauda equina nerves. This causes further deterioration in function in the areas that are controlled by those nerves.  In some cases the delay can mean the difference between suffering with urinary urgency or a difficulty passing urine to becoming fully incontinent and losing all sensation associated with passing urine. The same deterioration can occur with bowel function.  As a result of prolonged compression, people can suffer with neuropathic leg pain and sometimes experience a drop foot which can cause mobility issues.

Lost function cannot be restored, but if the pressure on the nerves is relieved quickly, it can prevent any further deterioration taking place.  

People with disability from CES have a lot to cope with and may feel overwhelmed by the thought of making a claim.  Is it worth making a claim for compensation?

Yes it is, absolutely. I would advise anyone whose SCI disability was caused by medical negligence to pick up the phone or send an email so that we can call you back, and find out more about how compensation could help you. 

The long-term impact of CES cannot be underestimated.  Once permanent damage has been done to the nerves, it is unlikely that lost function will be recovered. This leaves people having to manage lifelong issues with bladder and bowel function, and often severely impairs their mobility and independence. Education, work, travel, and home and family life can all be affected, leaving the injured person dependent on others’ help both within the home or to get out and about.

Compensation can’t reverse the injury, but provides a lifeline for our clients to care and assistance, necessary home adaptations, therapies and medical treatment, and specialist equipment, such as wheelchairs and adapted vehicles.  Our clients also find that compensation provides peace of mind, enabling them to meet lifelong needs and providing financial security for the future.

If you have suffered a spinal cord injury as a result of an accident or medical negligence, you can talk to one of our experienced solicitors, free and confidentially, by contacting us here.