There seems to be widespread agreement that surgery where a patient is exhibiting symptoms of incomplete cauda equina syndrome should be a matter of emergency. Once the patient’s symptoms have deteriorated, however, the best timing of surgery remains unclear.
Decompression surgery for incomplete cauda equina syndrome
For the patient who is developing cauda equina syndrome and starting to experience urinary problems as well as other typical symptoms such as lower back and leg pain or sensory loss in the saddle area, surgery to decompress the cauda equina nerves should take place within hours. Where surgery is delayed beyond 24 and 48 hours, there seems to be a less positive outcome for the patient.
Complete cauda equina syndrome
The patient is considered to be suffering with complete cauda equina syndrome when a number of the red flag symptoms are present, along with painless retention of urine and possible overflow or incontinence.
These symptoms indicate that the nerve function has deteriorated beyond the status of incomplete cauda equina syndrome.
Surgical outcomes with complete cauda equina syndrome
The general view seems to be that patients who undergo surgery with CESi experience better outcomes than patients with CESR who may be left with bladder, bowel and sexual dysfunction.
However, it would also seem that, in some cases, improvement of function does occur after decompression surgery, even where the patient is experiencing urinary retention.
It is not clear whether the timing of surgery affects this outcome once the symptoms have developed to this point and there is sometimes less urgency applied to these scenarios, although there is also some evidence that earlier surgery is still preferable.
Deterioration and medical negligence
The speed with which a patient will deteriorate from incomplete to complete versions of the condition is uncertain. What is clear is that the patient whose condition deteriorates to CESR risks a considerably poorer outcome. Therefore, the identification of the condition at its early stages and the emergency undertaking of decompression surgery before the patient’s condition deteriorates, would appear to be absolutely vital.
Where deterioration does occur and is seen to be due to failings on the part of medical professionals to recognise or act on early symptoms of cauda equina syndrome, it may be appropriate to make a claim for compensation.
Speak to a solicitor
If you have suffered a poor outcome from decompression surgery because your symptoms were not acted upon with adequate urgency, contact us to discuss your situation with a specialist medical negligence solicitor.