Is An Urgent Referral Needed for Cauda Equina Syndrome?

If a patient is displaying the red flag symptoms of cauda equina syndrome, he/she must be referred to hospital as a matter of urgency.

In this article we look at when a patient should be urgently referred, and when it might be appropriate for medical practitioners to take a different course of action.

Recognising the symptoms of cauda equina syndrome

Cauda equina syndrome is a rare neurological condition. It happens when the cauda equina nerves at the bottom of the spinal cord are compressed and damaged. Compression can occur in a number of ways, with a slipped disc being the most common cause.

When the cauda equina nerves are compressed, the first symptom to arise will be chronic lower back pain. This may turn into sciatica, whereby the pain radiates down through the buttocks and leg(s).

Chronic lower back pain and/or sciatica will not be enough to prompt medical professionals to urgently refer a patient. However, if a patient is also displaying other symptoms associated with cauda equina syndrome, medical practitioners should immediately suspect nerve compression and order further tests.

Symptoms that should prompt an urgent referral include:-

• Numbness between the legs and buttocks
• Bladder dysfunction – including difficultly urinating, reduced sensation while urinating and the increased frequency
• Bowel dysfunction – including incontinence due to poor anal tone and constipation
• Sexual dysfunction – including erectile dysfunction and loss of sensation
• Weakness in the legs

Referring a patient with lower back pain

Medical professionals should therefore consider the following guidelines when deciding whether or not to refer a patient with lower back pain:-

• If the red flag symptoms of cauda equina syndrome are present: refer with urgency.
• If there is progressive, persistent or severe neurological dysfunction: refer to a neurosurgeon or orthopaedic surgeon for assessment. Should be seen within one week.
• If pain or disability is present for over a week: refer to a physiotherapist or chiropractor.
• If sciatica is still causing problems after six weeks: refer to a neurosurgeon or orthopaedic surgeon for assessment. Should be seen within three weeks.
• If pain or disability continues despite physiotherapy: refer to a back pain service or chronic pain clinic.

If a medical practitioner fails to urgently refer a patient who is displaying the red flag symptoms of cauda equina syndrome, the standard of care will be considered unacceptable. If this causes a patient further injury, there will be grounds for a medical negligence claim.

To find out more about claiming compensation for cauda equina syndrome, please do not hesitate to get in touch with us today.

Please call us free on 0800 234 3300, from a mobile click to call 01275 334030 or complete our Free Online Enquiry for a no cost, no obligation opinion.

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