In the first part of our cauda equina series, I discussed cauda equina, the symptoms, treatment, and recovery. In this part, I cover the impact that the symptoms of cauda equina can have upon everyday life and what support is available. Every year more than 1,000 cases of cauda equina syndrome (CES) are recorded in spinal centres in the UK. Despite this, there is currently no standard NHS care pathway for people living with the effects of this life-changing condition. What is Cauda Equina Syndrome (CES)? Cauda equina syndrome is a condition which develops when the nerves at the bottom of the spinal column are compressed, sometimes by a disc herniation (slipped disc) or movement of the discs between the vertebra in the spine. Cauda equina syndrome requires early recognition, and often emergency surgery is needed to release the pressure on the nerves. People who experience cauda equina syndrome may be left with the some or all of following symptoms: impaired bowel function bladder dysfunction and possibly incontinence pain and numbness neurological pain mobility issues sexual dysfunction psychological symptoms What support is available? The NHS can support a person suffering with the after-effects of cauda equina syndrome by addressing specific, individual symptoms or concerns. At the moment there is no clear standard pathway for addressing the condition as a whole, and to understand the combined effect of, and interaction between, each aspect of the condition. As specialist cauda equina solicitors, we can’t change what has happened in the past, but we can signpost our clients to sources of help. Where a claim for negligent care relating to a delay in diagnosis or treatment of cauda equina is possible, we try to ensure that the compensation claim provides the necessary funding to meet the additional needs of the individual for the rest of their lives. I often see clients who have bladder dysfunction, and have either urinary urgency or suffer with urinary retention. Urological support from continence teams can help a patient learn to self-catheterise, to ensure that the bladder is emptied regularly and fully, and thus avoid recurrent urinary tract infections. Some clients experience bladder dysfunction with a degree of urgency and for these clients, bio-feedback (specialist physiotherapy) can sometimes be effective in re-training the muscles around the bladder to help relieve these symptoms. Constipation is a common problem following cauda equina syndrome. Bowel specialists can help educate patients about diet and bowel management, and irrigation systems can be used to help clear the bowel and avoid chronic constipation occurring. Some clients in the past who have undergone sacral nerve stimulation insertion, with an electronic device inserted to help stimulate the nerves that have been damages and which helps to manage bowel function. Where a client suffers from neuropathic pain, they might benefit from help from a pain specialist. How long can it take to get help? It is quite common to be told that the symptoms that follow cauda equina compression can take a year or two to settle down or for any improvement to occur. With the current NHS care pathway focussing on individual aspects of the injury, instead of treating the person as a whole and bringing multi-disciplinary treatment to the patient, there will inevitably be long waiting times between appointments with different specialist consultants. Is psychological support necessary? I have worked with a number of clients whose ongoing symptoms as a result of cauda equina syndrome have meant that they have been unable to return to work in the same capacity as before the injury. Some struggle to return to work at all because of the impact and complexity of their symptoms. Clients who experience cauda equina syndrome often continue to experience significant back pain despite surgery to remove the pressure on the nerves at the base of the spine. Neuropathic pain, foot drop, impaired mobility, bowel/bladder and sexual dysfunction can all have a psychological impact on an individual. The invisible nature of this condition can leave people isolated from friends and family. It can take time and help to adjust to the change in their lives. Cauda Equina Spinal Cord Injury (CESCI) Having seen for ourselves the effects of cauda equina syndrome, Boyes Turner are pleased to support Allison and Nigel Whitehorn with their support group called Cauda Equina Spinal Cord Injury (CESCI). The group offers help and support for those affected by this life-changing condition but also works with medical professionals to educate them on the signs and symptoms of cauda equina and the importance of timely treatment. CESCI founder, Allison Whitehorn, is a long-term sufferer of cauda equina syndrome, and with her husband formed the support group to provide a forum for those in a similar situation to her own. The support group aims to help people learn about ongoing symptoms, offer advice on how to adapt and access support, and achieve a happy and fulfilling life. Group meetings are held across England and Wales and provide a safe place for individuals to talk with others living with the condition. There are online support group meetings as well, and support for the partners of those living with CES. The group also works with medical professionals to provide advice to members on medical products, devices and aids and equipment that might help them manage their symptoms. What can lead to a cauda equina negligence claim? Cauda equina may be missed when a doctor: fails to listen to the patient’s description of their symptoms fails to question the patient carefully about their symptoms fails to examine the patient properly fails to identify or rule out “red flag” (emergency) symptoms of cauda equina incorrectly diagnosed back pain without checking for cauda equina fails to arrange urgent surgical review and treatment for a patient with cauda equina red flag symptoms fails to advise a patient with symptoms of back pain to call for urgent medical help if they develop symptoms of cauda equina CES claims can also arise from: negligent cauda equina decompression surgery failure to recognise and treat post-operative complications Our cauda equina syndrome cases Our medical negligence solicitors have secured millions of pounds in compensation for those with cauda equina syndrome. You can see our previous cases here. If you or a member of your family have suffered disability from delayed diagnosis or treatment of cauda equina syndrome and would like to find out more about making a claim, contact us by email at mednegclaims@boyesturner.com.
