When diagnosing cauda equina syndrome, the investigation of choice should be an MRI scan.
Cauda equina syndrome
Cauda equina syndrome is when the bundle of nerves at the base of the spine – called the cauda equina nerves – is compressed. Compression can happen for a variety of reasons, most commonly due to a slipped disc.
Compression of the cauda equina will result in certain clinical symptoms, most notably chronic back pain, urinary dysfunction and loss of sensation in the perineum/buttocks/upper legs.
MRI scan for cauda equina syndrome
These symptoms should prompt medical practitioners to suspect cauda equina syndrome. However, the only way a firm diagnosis can be achieved is with an MRI scan. A patient should therefore be sent for an emergency MRI scan, meaning within around four hours of presenting to hospital.
An MRI scan must be carried out on an emergency basis because cauda equina syndrome has to be treated very quickly, or permanent complications will arise.
The MRI scan should clearly show whether or not the cauda equina nerves are being compressed. It should also reveal the cause of compression – be it a tumour, slipped disc or something else.
If doctors suspect compression is being caused by an infection, they may choose to inject a harmless dye into the patient. This will show up on the MRI scan, providing more detail as to where the infection lies.
What if I cannot have an MRI scan?
Some patients will not be able to have an MRI scan for medical reasons. For example, patients should not have an MRI scan if they have a pacemaker, aneurysm clips and metal fragments close to the eyes or organs.
Patients who cannot have an MRI scan should undergo a CT myelogram instead.
What will happen after the MRI scan?
Approximately 75% of patients sent for an MRI scan with suspected cauda equina syndrome will have a negative result. In other words, they do not have cauda equina syndrome. In such cases medical practitioners can rule out nerve compression and must consider an alternative diagnosis.
Those patients who are diagnosed with cauda equina syndrome should proceed straight to emergency surgery. This is needed to decompress the nerves. The only reason emergency surgery might not be deemed necessary is if the condition is already complete, meaning a patient has lost all control over their bladder. For these patients the nerves cannot be repaired and surgery can be delayed until the following day.
Failure to refer patient for MRI scan
If your cauda equina syndrome treatment was delayed because medical practitioners failed to refer you for an emergency MRI scan, you could be the victim of medical negligence. Contact us today to find out more.