Cauda equina syndrome has to be diagnosed and surgically treated quickly. Without timely medical intervention, permanent nerve damage will occur.
Diagnosing cauda equina syndrome in 5 steps
In order to diagnose cauda equina syndrome accurately in a timely manner, medical practitioners must take the following steps:
1. Recognise symptoms of a neurogenic origin
Cauda equina syndrome will lead to a group of symptoms which together indicate nerve damage. These symptoms will get progressively worse with time. Symptoms of cauda equina syndrome include loss of perineal sensation, bladder dysfunction and leg/back pain.
2. Neurological examination
To verify whether a patient’s symptoms are being caused by nerve damage, he/she must undergo a neurological examination.
Neurological examination will reveal reduced sensation in the saddle region, perianal and perineal region. There will be an abnormal digital rectal examination with reduced tone of the anal sphincter and an absence of a voluntary squeeze. There will also be absent reflexes in the lower limbs with an abnormal straight leg raise test.
3. Arrange investigations
These clinical examination features are in keeping with an injury to the cauda equina. Following on from this examination, medical practitioners should immediately consider the possibility of cauda equina syndrome and order further investigations. The diagnostic tool of choice for cauda equina syndrome is an MRI scan.
4. MRI scan
An MRI scan should either be performed on an urgent basis or an emergency basis, depending upon the clinical situation. If a patient is thought to be in the first stage of the condition – called incomplete cauda equina syndrome – then the MRI scan is an emergency. But if the patient has progressed to the second and final stage of the condition – called complete cauda equina syndrome – the MRI scan can be carried out on an urgent basis.
5. Interpret the scan results
The MRI scan should reveal whether or not the cauda equina nerves are being compressed. If so, it should also show what is causing the compression – be it a centrally prolapsed disc, a spinal tumour, narrowing of the spinal canal or something else.
What happens next?
Once cauda equina syndrome has been diagnosed, a patient should quickly undergo lumbar decompression surgery. Like the MRI scan, this may be done on an emergency or urgent basis according to the clinical situation. If the patient still have incomplete cauda equina syndrome, emergency surgery is required. If the patient has gone into retention, urgent surgery will suffice.
Expert legal advice
If doctors did not manage to diagnose your cauda equina syndrome in time, meaning your treatment was delayed, you could be the victim of substandard medical care. Contact us to find out if you can claim compensation.