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Preventing the Progression from Incomplete to Complete CES

It is important to prevent cauda equina syndrome progressing to the complete stage or a patient will be left with long-term complications.

Incomplete cauda equina syndrome (CES-I)

Cauda equina syndrome (CES) is a collection of symptoms that arises when the cauda equina nerves become compressed and injured. Compression can happen in any number of ways, with a central disc prolapse being amongst the most common.

When symptoms first appear, a patient will be in the incomplete stage. These symptoms will include chronic back pain, bladder dysfunction and loss of perineal sensation.

Most importantly, a patient with incomplete CES will retain bladder control. It may be difficult to pass urine and there may be a loss of urethral sensation, but a patient will know when he/she needs to pass urine, and will be able to achieve this to some degree.

Complete cauda equina syndrome (CES-R)

As the condition progresses, the nerves will become increasingly damaged and a patient’s symptoms will deteriorate. Chronic back pain, perineal numbness and bladder dysfunction will all still be present, but will be increasingly severe.

Eventually the injury to the nerves will be so extensive that the root cells die. At this stage the condition has progressed to the complete stage.

The most telling sign that a patient has progressed from incomplete to complete is that he/she will have no sensation in their bladder and will not be able to control the passing of urine. This will lead to painless urinary retention and overflow incontinence.

Treating incomplete and complete cauda equina syndrome

Cauda equina syndrome must be treated in the incomplete stage. This will give the patient a better chance of making a full recovery. Once the condition has progressed to the complete stage, treatment will have little positive impact. The damage will normally be irreversible and a patient will be left with long-term neurological problems.

Preventing the progression of cauda equina syndrome

The only way to prevent cauda equina syndrome progressing from the incomplete to the complete stage is to decompress the nerves through surgical intervention. This must be carried out as soon as possible, and certainly before complete bladder retention occurs.

Preventing the progression of cauda equina syndrome therefore depends upon the ability of medical practitioners to make a timely diagnosis and act with urgency. If they fail to do so and a patient progresses to the complete stage of cauda equina syndrome, there may be grounds for a medical negligence compensation claim.

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