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.

The position in law is that a patient who has been injured as a result of medical negligence has three years from the date of the negligence which caused the spinal injury to issue court proceedings.

If the person fails to issue court proceedings within that time, the claim will be statute barred. This can mean that they lose their right to bring a claim.

The three-year deadline is known as the limitation period.

There are the following exceptions to the three-year rule:

• if a child is injured before they are 18, their three-year deadline expires on their 21st birthday. In other words, their time doesn’t start to run until they are 18;
• if the injured person is mentally disabled (lacks mental capacity) then their time doesn’t begin to run at all, unless their mental capacity is restored;
• where the injured person has died before the limitation period has expired, the three-year time period expires three years after the date of their death;
• if the injured person did not suspect or could not reasonably think they had been injured by negligence, the three-year time period will start to run when the injured person first became aware (or should have suspected) that they had been injured by negligent care;
• the court has a general discretion to extend the time limit in cases where none of the above exceptions apply, but only does so in exceptional circumstances.

Regardless of your time limit, we recommend that you contact our specialist cauda equina medical negligence solicitors as soon as you can, even if you are still only considering whether to make a claim for a delay in diagnosis and/or treatment of cauda equina syndrome.

There are generally three ways to fund a medical negligence claim.

These are:

• Legal Aid (available only for cerebral palsy birth injury and neonatal severe brain injury claims);
• A no win no fee arrangement; or
• Legal expense insurance. We provide full and straightforward advice to our clients about the funding options that are available to them and best suited for their own or their child’s claim.

Most medical negligence claims relating to cauda equina syndrome are handled on a no win no fee basis.

You can make a cauda equina syndrome claim if your condition has been caused or worsened by poor medical 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.

Cauda equina 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).

A delay in diagnosis or treatment can cause a worsening of cauda equina symptoms.

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;
• surgical errors.

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.

The general rule is that urgent surgery is carried out to prevent ongoing compression of the cauda equina nerve roots. The surgery relieves the compression on the nerves. However, quite often the damage that has been done by the compression cannot be undone, although some people do experience some improvement in their symptoms after decompression or discectomy surgery.

We ask a medical expert to comment on what difference earlier surgery would make in each individual case when investigating a claim.

The duration of a medical negligence claim depends on the individual circumstances of the client’s case.

The claim is likely to take less time to conclude where liability is admitted by the defendant (usually NHS Resolution on behalf of the hospital or doctor).

Circumstances which make the claim more complex and, therefore, take longer to resolve include:

• where NHS Resolution or the defendant disputes that they were negligent or that the medical treatment given (even where admittedly negligent) caused the client’s injury;
• where multiple experts in different disciplines are needed to assess complex injuries and the likely long-term outcome. Our medical negligence solicitors work hard to secure early admissions of liability and substantial interim payments so that we can begin to alleviate the financial hardship that can arise after a life changing spinal cord injury.

With liability judgments secured and interim funds in place, the individual and their family can focus on rebuilding their lives whilst we concentrate on valuing and negotiating settlement of the claim.

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.

If you have suffered from CES and suspect medical negligence, it's essential to seek legal advice from a specialist medical negligence solicitor. They can assess your case, advise on your options, and help you pursue a claim if appropriate.

To find out more, contact us for free and confidentially, by email or phone.

Cauda equina syndrome is a syndrome of symptoms and signs. There are many different definitions of CES.

Back pain, usually severe, is present with sciatic symptoms. The sciatica can be unilateral or bilateral.

If you have CESI you will probably have some bladder function but it might not be “normal.” This can mean that there can be impaired bladder sensation, impaired urethral sensation, poor stream or some urinary urgency or frequency. You have not usually come to the point of having painless urinary retention (not knowing the bladder is full and then experiencing incontinence).

You might also have impaired rectal sensation, genital/peri-anal sensory disturbance and/or reduction in anal tone.

If there is prompt surgery during this stage it may produce a reasonably favourable outcome.

If you have CESR you will usually have reached a point of bladder paralysis and painless urinary retention, alongside a loss of saddle sensation or saddle anaesthesia.

This can sometimes also be evidenced by overflow incontinence – not realising the bladder is full and then suffering incontinence.

Surgery after this point is unlikely to alter the outcome though some recent medical studies have shown some improvements after prompt surgery in patients with this classification of CES.

There are various tests that can be carried out to help diagnose CES. The most common are:

• pin prick test – a blunt pin is used to check for altered sensation in the lower body and around the saddle area;
• digital rectal examination – used less commonly now, but sometimes carried out to test anal tone and anal squeeze.
• Straight leg raise - You lie on your back and the doctor will lift your legs up, keeping your knees straight, and ask if and when you feel pain.
• Bladder scan – this should be carried out pre and post void and will measure the amount of urine in the bladder. If you are retaining urine, or finding it difficult to void this can be a key indicator (usually in the presence of some saddle anaesthesia) of CES.