Cauda Equina Syndrome and Herniated Discs

Cauda Equina Syndrome can be caused by a variety of different reasons, one of which is a herniated disc. In this article we explore the condition more closely, explaining how a herniated disc can caused nerve compression and what treatment must be given if a patient is to make a full recovery.

How does a herniated disc cause cauda equina syndrome?

The adult spine is made up of a 24 vertebrae. Between each of these vertebrae is a disc which acts as a cushion, absorbing the impact of spinal movement. As we age, our spinal discs gradually degenerate, becoming weaker and thinner. Eventually this general wear and tear may cause a disc to rupture or ‘herniate’, something which may also be caused by a traumatic injury.

Herniated discs most commonly occur in the lower back between the fourth and fifth lumbar vertebrae. This is because our lower back carries the weight of our upper body, particularly when sitting and standing. However, a ruptured lumbar disc can be extremely dangerous as it is possible it will put pressure on the cauda equina, a bundle of nerves located at the bottom of the spinal cord.

What treatment should be provided for a herniated lumbar disc?

When a herniated disc is compressing the cauda equina, the ‘red flag’ symptoms of Cauda Equina Syndrome will quickly develop. These include:-

• Sciatica in both legs;
• Sensory disturbance of the ‘saddle area’ (ie. the perineum);
• Poor reflexes;
• Bowel/bladder dysfunction;
• Altered sexual sensation.

If a patient presents with these symptoms, medical professionals should immediately consider the possibility of Cauda Equina Syndrome (CES). Tests should then be carried out to determine whether or not this suspected diagnosis is correct, and if so, what the underlying cause is. The investigation of choice is ordinarily an MRI scan which should reveal the presence of a herniated disc. Once Cauda Equina Syndrome is diagnosed, treatment should be provided without delay. This should involve emergency decompression surgery to remove the herniated disc.

Does a delay amount to medical negligence?

However, if there is a delay in diagnosis and treatment, the herniated disc will continue to compress the nerves. This will cause an increasing amount of damage until eventually the injury is irreparable. Consequently a patient will suffer long-term neurological complications such as poor bowel and bladder control, sexual dysfunction and on-going pain. It is generally accepted that decompression surgery must be carried out within 48 hours of the onset of symptoms. Any longer than this and the outcome is likely to be less favourable.

If there is a delay and a patient is left with permanent damage, it must be considered whether this delay was the fault of medical professionals. For example, did doctors recognise the red flag symptoms in a prompt fashion? Were the appropriate tests carried out and accurately assessed? Was surgery arranged as a matter of urgency? If there was a failure to do any of these things, there could be a case of medical negligence.

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