Cauda Equina Syndrome - A Cause for Concern

Back in March I commented on a warning that was issued by the Medical Defence Union (MDU) to GPs in relation to cauda equina syndrome (CES).

Since 2005, the MDU, which provides representation and indemnity to doctors, had paid out £8 million in compensation to patients who had been disabled as a result of delayed diagnosis and treatment of this serious neurological condition. The MDU’s warning reminded doctors that cauda equina is a medical emergency requiring prompt recognition and action when a patient presents with red flag symptoms.

More recently, another of the leading medical defence organisations, The Medical Protection Society (MPS), has included failure and delay in diagnosis of cauda equina syndrome in its list of the top five areas of general practice which give rise to the most expensive negligence claims. CES featured at the top of the list, which was based on the MPS’s own claims data, according to their report, The Rising Cost of Clinical Negligence: Who Pays The Price?

When the nerve roots below the termination of the spinal cord are compressed from physical trauma, infection and inflammation, a prolapsed (slipped) disc, or tumour, the patient must be referred urgently to hospital for surgical decompression. Even short delays can result in permanent loss of function and disability, which is why it is so important for GPs to know and act upon the danger signs. These are known as red flag symptoms and include:

  • Pain on both sides radiating below the knee
  • 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

Recognition of the signs of CES can be complicated where a patient has a pre-existing back condition, so careful examination and questioning must be undertaken to establish the cause of the pain. If red flag symptoms are identified, the patient’s GP should contact the hospital’s neurosurgical or orthopaedic specialist for immediate advice or arrange for the patient’s emergency admission to hospital.

Boyes Turner’s medical negligence specialists secure maximum value compensation awards for clients disabled through negligent delay in diagnosis and treatment of cauda equina syndrome.

Settlements have included:

The service provided was first class. You were understanding, caring and professional

David Froud

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