Updated NICE guidelines on cauda equina syndrome should ensure more prompt referrals for medical investigation and a quicker route to surgery for this shocking condition.
The urgency of a cauda equina syndrome diagnosis
Cauda equina syndrome is a medical emergency. A patient who is developing this appalling condition ideally needs to undergo surgery before the compression of their cauda equina nerves becomes irreversible.
Failures on the part of medical practitioners to understand the symptoms of cauda equina syndrome, to refer a patient in a timely manner and to undertake surgery with sufficient urgency has led to numerous patients suffering debilitating lifelong symptoms. It has also led to numerous, highly-expensive compensation claims.
These circumstances have led NICE, the National Institute for Health and Care Excellence, to amend their guidelines to try to ensure that medical practitioners have a higher suspicion of cauda equina syndrome at an earlier stage of development; that patients are aware of the symptoms to look out for; and that the key moment for a referral for an emergency MRI scan is not missed.
Revised guidelines
Revised guidelines state the red flags for cauda equina syndrome to be the following:
- Bilateral sciatica
- Severe or progressive bilateral deficit of the legs, such as major motor weakness with knee extension, ankle eversion or foot dorsiflexion
- Difficulty initiating micturition or impaired sensation of urinary flow, if untreated this may lead to irreversible urinary retention with overflow urinary incontinence
- Loss of sensation of rectal fullness, if untreated this may lead to irreversible faecal incontinence
- Perianal, perineal or genital sensory loss (saddle anaesthesia or paraesthesia)
- Laxity of the anal sphincter
Failing to recognise the red flags
Patients attending their medical professional with possible early symptoms of cauda equina syndrome, such as pain in the lower back and one leg with possible weakness or tingling, need to be made aware of the red flags above and the need to attend A&E as a matter of emergency should they start to develop these symptoms.
If a medical professional fails to warn the patient of these symptoms, they may be considered to have acted negligently. If the patient subsequently deteriorates and suffers from a delayed diagnosis and treatment as a result, they may be entitled to make a claim for compensation.
Medical negligence
Patients whose cauda equina diagnosis is delayed risk a very poor outcome indeed. Complete cauda equina syndrome can leave the patient with bowel, bladder and sexual dysfunction as well as severe mobility problems. Prompt diagnosis and treatment, however, can facilitate recovery of lost function.
If you or a loved one are suffering these appalling effects due to a failure by medical professionals to act on your red flag symptoms, contact us to discuss your situation with a specialist medical negligence solicitor.