What is Cauda Equina Syndrome or CES ?

Cauda Equina Syndrome is a neurological condition and is generally considered as a form of spinal cord injury.

The cauda equina, otherwise known as the horse’s tail, is called this because of its appearance. It is situated at the lower end of the spinal cord. The spinal cord is shorter than the spinal canal in which it runs. It ends at the first or second lumbar vertebrae. The cauda equina contains the nerve roots from L1-5 and S1-5.

Cauda equina syndrome can often be caused by compression of this group of nerves. It has been defined as low back pain, sciatica with pain in one or both legs, sensory disturbance around the saddle area, loss or altered function of the bladder and bowel, and variable lower extremity motor and sensory loss.


What can cause Cauda Equina Syndrome ?

Cauda equina syndrome is caused by significant narrowing of the spinal canal which compresses the nerve roots below the level of the spinal cord.

There are a number of possible causes which include the following :

  1. Compression of the nerves by prolapsed disc, or any other form of spinal injury such as a fracture
  2. Stretching for example, where one vertebrae slips on another
  3. Inflammation, in conditions such as an abscess in the spine.
  4. Spinal tumours
  5. Lumbar puncture or spinal tap. This can cause a collection of blood in the spinal canal in patients receiving medication to thin the blood. This collection of blood has been seen to compress the nerves and cause CES.

CES due to compression, for example when there has been a fracture, may respond well to speedy decompression surgery, but how well a person will recover will depend upon how long the syndrome continued before decompression was achieved.


Management

If a person has chronic CES it can be much harder to treat.

The pain is usually treated with strong analgesia. If the person has problems with bladder control, medication will be given or the person may have to use intermittent self-catheterisation if the bladder is unable to empty.

Other ongoing problems may include bowel symptoms with incontinence of faeces but also incontinence of flatus. A common problem is severe constipation and so enemas and other measures such as laxatives may be necessary.

There may be sexual dysfunction with sensory loss and in males, a complete loss of sexual function.

There may be loss of sensation in the feet or legs. Some people describe having small areas of sensation on the base of the foot, but when in a standing position, they do not have full sensation in the base of the foot, and so have problems with balance.


What can happen if there is a delay in diagnosis ?

The longer this condition is left untreated, the more damage can result. Many experts provide opinions in this field. Some will say that once there is incontinence of urine, then even with decompression surgery, the outcome for the patient will be very poor. However, others say that there is a window of 24-48 hours for surgery, and if decompression is achieved within this timescale, the outcome for the patient will be much better. They may have some residual disabilities, but will generally be able to manage day to day tasks and will generally have enough bowel and bladder control to enable them to continue working.


Can I make a claim ?

All of these cases have to be looked at on their individual facts. However, if you feel there has been a delay in diagnosing and treating your CES, then please contact Thompsons Solicitors Clinical Negligence Department.


Recent cases where we have achieved a successful outcome for clients

1. Mrs X developed sudden and severe pain in her back. An ambulance was called and she was taken to her local hospital for an emergency examination. She was seen by a Doctor who examined her and took blood for testing. The blood showed signs of an infection. Following an x-ray of her spine she was diagnosed with musculo-skeletal pain and was discharged.

Her pain continued and became progressively worse. She was unable to lie flat and had to sleep in a chair. Her GP arranged further blood tests and referred her back to the hospital. She was again admitted and arrangements were made for her to sleep in a chair next to her bed because she was still unable to lie flat.

Blood tests again showed a high white cell count indicating an infection. Despite this test result the doctor made a diagnosis of polymyalgia rheumatica, a condition which causes inflammation and pain in the large muscles, and she was again discharged home.

The severe pain continued and a few days later in the early hours of the morning she had a sudden spasm in her legs and by 5.30am she had become paralysed. An ambulance was called and she was admitted to hospital. This time, cauda equina syndrome was diagnosed.

Following an MRI scan she was told there was irreversible damage to her spine with compression of the spinal cord.

Thompsons Solicitors were instructed to investigate the claim. Experts provided independent opinions and the claimant was able to establish that if she had simply been prescribed the correct course of antibiotics, she would have made a full recovery. Instead she had to be transferred to another hospital where she underwent a fusion operation on her spine. The surgeon found extensive infection in the spine.

Since that time she has been paralysed from the chest downwards and is reliant on a wheelchair.

Thompsons Solicitors secured the sum of £900,000 in compensation for her. Some of this money has been used to buy a bungalow for this client which has been adapted for her needs.

2. Another client secured a compensation award of £820,000 following a delay in diagnosis of CES. She suffered a fall at home and landed with a vacuum cleaner under her spine. She had also broken her hip and this is what the doctors appeared to concentrate on when she was taken to the hospital, despite her complaining of loss of sensation in her feet. Nine days later, a different doctor took notice of this complaint, she was referred for an urgent MRI scan. A fracture of the vertebrae was identified. However, the fracture resulted in CES and despite decompression being attempted, this client was left with severely restricted mobility, and loss of sensation in her bladder and bowels.

Again, some of her compensation has been used to purchase an adapted bungalow which is suitable for her needs. The experts instructed in this case also advised that with earlier decompression surgery, this client could have returned to her pre-injury state of mobility and day to day activities.

If you would like further advice about a clinical negligence claim, please contact the team at Thompsons Solicitors clinical negligence department. You can reach us on 08000 224 224 or by completing one of our online personal injury compensation claim forms.