Surgery For Incomplete/Complete Cauda Equina Syndrome

If a patient presents with complete cauda equina syndrome, it may not be necessary to proceed with emergency surgery as the damage will already be done. However, if a patient presents with incomplete cauda equina syndrome, no time should be wasted in decompressing the nerves.

Cauda equina syndrome

The nerve roots at the end of the spinal cord are called the cauda equina nerve roots. The cauda equina nerves serve a number of functions, primarily providing perineal sensation, bladder and bowel control, and sexual function.

If the cauda equina nerves become compressed for any reason, they will soon become damaged and function will become impaired. This will result in symptoms such as perineal numbness, poor anal tone and urinary dysfunction, including incontinence.

When such symptoms arise because of cauda equina compression, a patient is said to have cauda equina syndrome.

Incomplete and complete cauda equina syndrome

When cauda equina syndrome first occurs, it will be in the incomplete stages. A patient will have the red flag symptoms of cauda equina syndrome, and most importantly will still have some control over their bladder. There will be a degree of urinary dysfunction – for example, it may be necessary to strain in order to urinate – but a patient will be able to tell when their bladder is full, and exert some control over the passing of urine.

As the nerves become increasingly damaged, the condition will progress from incomplete to complete. Complete cauda equina syndrome is characterised by the total loss of bladder sensation. A patient will not be able to tell when he/she needs to pass urine, and the bladder will become so full that it eventually overflows, causing an episode of urinary incontinence. This is called painless overflow incontinence.

Operating on incomplete/complete CES

If a patient presents with incomplete cauda equina syndrome (CES-I), he/she must be sent for an urgent MRI scan to verify cauda equina compression. Once confirmed, emergency decompression must be carried out to prevent complete cauda equina syndrome (CES-R) from occurring.

However, if a patient presents to hospital already in the complete stages, a recovery is unlikely. Therefore emergency surgery is not needed. An operation may be carried out the following day, or may not be deemed necessary whatsoever.

Delayed treatment of CES-I

If a patient presents to their GP or hospital with CES-I but treatment is not given before the bladder become paralysed, there will be grounds for a compensation claim. This is because failing to appreciate the objective signs of CES will amount a poor standard of care. This will lead to a patient developing the serious complications associated with complete CES, making him/her the victim of medical negligence.

If you believe you could be entitled to make a cauda equina claim, contact us today to find out more.

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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