Treating Incomplete Cauda Equina Syndrome

When Cauda Equina Syndrome is expected, medical professionals must act urgently, as the condition must be treated while it is still in the incomplete stage. If doctors delay – perhaps because they fail to make a prompt diagnosis or fail to recognise the severity of the situation – the condition will progress into the complete stage. This means extensive nerve damage will have already occurred, making further treatment ineffective.

Incomplete and complete Cauda Equina Syndrome

Cauda Equina Syndrome (CES) develops when the nerves found at the bottom of the spinal cord become compressed. This will lead to symptoms such as:-

• Dysfunction of bowel, bladder or sexual function;
• Sensory changes in the saddle or perineal area;
• Back pain;
• Sensory changes in the lower limbs;
• Lower limb weakness;
• Reduction or loss of reflexes in the lower limbs.

When a patient first presents with these symptoms, he or she will still be in the early stages of the condition – known as the incomplete stage. The most discernible characteristic of incomplete CES is that of urinary disturbance, with altered urinary sensation, loss of desire to void, poor urinary stream and a need to strain all tell-tale signs of nerve compression.

As pressure continues to be placed upon the nerves, they will become increasingly damaged, causing a patient’s condition to worsen. Although this deterioration can be gradual, it is not uncommon for a patient to suffer irreparable injury within 24 hours of the onset of symptoms. When permanent nerve damage does occur, a patient is said to have complete Cauda Equina Syndrome, something which is associated with painless urinary retention and incontinence. Put simply, a patient will no longer have control over their bladder.

Why must Cauda Equina Syndrome be treated in the incomplete stage?

However, it is absolutely vital that a patient does not progress to the complete stage of the condition. This is because by the time urinary retention is established it will be too late to recover the situation, meaning a patient will be left with permanent neurological complications. Emergency decompression of the cauda equina must, therefore, be performed during the incomplete stage, as this is the only way to ensure a patient has the best chance of recovery. If surgery is delayed, treatment may ultimately prove to be futile.

What is a delay is the fault of medical professionals?

If surgery to treat Cauda Equina Syndrome is delayed, it must be considered who (if anyone) is to blame. There are times when a patient will not seek medical advice until the condition has advanced to the complete stage. However, it is also possible that medical professionals are at fault. For example, if doctors fail to recognise the symptoms in the early stages, fail to make a timely diagnosis or fail to appreciate the need for urgent treatment, their actions (or rather inactions) will have caused a patient irreparable complications. This will amount to medical negligence, and anyone injured as a result will be entitled to claim compensation.

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