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Pitfalls in Cauda Equina Syndrome Care

If the cauda equina nerves are decompressed before painless urinary retention occurs, then on the balance of probabilities the patient’s situation will be greatly improved.

Sadly decompression surgery is not always carried out in time and a patient is left with permanent neurological dysfunction. Often this happens because of pitfalls in cauda equina care.

In this article we will explore the common pitfalls of cauda equina syndrome treatment, explaining how medical errors can result in the delay of CES treatment.

Timing of treatment for cauda equina syndrome

Cauda equina syndrome causes lower back pain, sciatica (which may be bilateral), perineal numbness and bladder failure. The condition needs prompt recognition and urgent surgery. This is because the nerves are being compressed and damaged. The longer compression continues, the more extensive the damage will be.

The timing of surgery is therefore critical. The timing depends upon the clinical signs and imaging tests. A patient who still has some control over their bladder has ‘incomplete’ cauda equina syndrome. This requires immediate surgery as there is a good chance that function will be recovered.

On the flip side, if a patient has painless retention of urine, the condition is ‘complete’ and surgery will not produce much of an improvement in symptoms.

Common pitfalls

There are various reasons why cauda equina syndrome might not be recognised and treated by medical practitioners.

First and foremost, it is a rare condition and many GPs will not have dealt with a case of cauda equina syndrome during the careers. This is a problem as many patients with lower back pain will first seek help from their GP or possibly A&E. However, a very low proportion of patients with back pain have cauda equina syndrome, and as such medical practitioners fail to consider the possibility of spinal nerve compression.

Even if a doctor does suspect nerve compression, a diagnosis can only be confirmed with an MRI scan. Nevertheless, MRI scans are not readily available. It is still a specialist test and it may not be immediately available, meaning a patient does not have rapid access to an MRI scan that he/she desperately needs.

Once cauda equina syndrome is diagnosed, there may be an issue with providing emergency spinal surgery. Surgeons have daily lists of patients and it may not be possible to fit a patient in, even if rapid access is required. There may also be problems if the on-call surgical team is needed.

Have you suffered from medical errors?

If the treatment of your cauda equina syndrome was delayed because of medical error, please get in touch with us to discuss the possibility of making a cauda equina claim.

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