What is Cauda Equina and how should it be treated?

Cauda Equina syndrome is a rare condition and a medical emergency which requires fast treatment to prevent long term damage to the spinal cord.

At each level of the spine there are nerves which branch off from your spinal cord. These are known as nerve roots. These send signals around the body to and from muscles and other structures.

Cauda Equina develops when the nerves at the base of the spine suddenly become compressed andare squeezed together. These nerves are known as Cauda Equina. These nerves send and receive messages to and from your legs, feet, bladder, and bowels.

What Causes Cauda Equina Syndrome?

The most common causes of Cauda Equina syndrome are:

• A severe bulging or ruptured disc
• Narrowing of the spinal canal (stenosis)
• Tumours
• A spinal infection, inflammation, fracture or haemorrhage
• A serious spinal injury caused in an accident such as a car accident, or a fall
• Vascular problems of the Cauda Equina

Signs and Symptoms:

The symptoms of Cauda Equina can vary but mainly include:

• Pain on both sides of the lower back
• Weakness or numbness in both legs which is severe or getting worse
• Numbness around or under your genitals or around your anus
• Finding it difficult to urinate or a lack of control when urinating
• Not being aware of the need to empty your bowels or a lack of control when passing a stool

A bulging or herniated disc is where the coating of a disc in your spine tears causing the jelly like filling in the centre spills out. This can lead to the torn disc pressing on surrounding nerves causing pain in parts of your legs.

This pain can be accompanied by tingling, numbness, pins and needles or weakness in certain areas of your legs. The pain is often referred to as a sciatica and can be worsened when coughing, sneezing or straining.

Sciatica which occurs on both sides can be a sign of Cauda Equina.

Cauda Equina can destroy people’s lives due to long term significant problems it causes such as incontinence, ongoing pain, restricted mobility and sexual dysfunction.

There is no denying that lower back pain is extremely common especially as one ages. In the vast majority of cases the lower back pain is no concerning and can be treated. However, it can be more serious.

There are red flag signs and symptoms which your doctor, physiotherapist, chiropractor or a hospital should look out for. These are:

• Saddle numbness – losing feeling between the legs, numbness around the genitals or back passage, being unable to feel the toilet paper when wiping.
• Bladder impairment– being unable to urinate, difficulties staring to urinate, being unable to stop urinating, losing sensation when urinating, loss of full bladder sensation.
• Bowel impairment– being unable to stop a bowel movement, constipation or a loss of sensation when passing a stool
• Sexual dysfunction– being unable to sustain an erection or ejaculate, or a loss of sensation during intercourse.
• Nerve root pain– a combination of back pain, leg pain, leg numbness or weakness.

Examination

If you attend your GP with any of the symptoms above, your GP should carry out a full examination which should include:

• Testing limb weakness
• Checking if there is any gait disturbance
• Checking your reflexes
• Asking whether you are experiencing any urinary incontinence or retention
• Asking whether you are suffering numbness to your saddle area
• If needed, performing a rectal examination to check for loss of anal tone

Treatment

If Cauda Equina is suspected then the patient should be urgently referred for an MRI scan.  If this shows Cauda Equina Syndrome then emergency surgical treatment is required. Surgery is needed to relieve the pressure on those nerves which have been compressed. The surgery should happen within 24-36 hours in extreme cases. Unfortunately, if a patient is left too long without surgery this can damage the nerves beyond repair and no treatment can reverse the damage done. This results in permanent problems with motor and sensory function.

Case Studies

Examples of where medical negligence has occurred in cases of Cauda Equina Syndrome include:

• A failure by a GP, physiotherapist or chiropractor to urgently refer to Hospital
• A failure by the hospital to perform an MRI sooner
• A misreading of the MRI scan by a Radiologist
• Inadequate or negligent surgery
• Post-operative complications or damage suffered during surgery

 

A case study of a successful claim for compensation for Cauda Equina negligence involved a 24 year old woman, Jennifer who had experienced a sudden onset of lower back pain radiating down her buttocks and right leg. She called her GP and attended the surgery that same day. She was diagnosed with sciatica and provided with an injection to ease her pain. She was also prescribed pain relief.

She re-attended her GP a few days later with a worsening of symptoms which included a strange sensation to her inner right thigh. She was told to continue with pain relief, to rest, and her condition would improve over time. Her condition continue to worsen over the next few days. She struggled to sleep, and could not sit down properly. She also began to suffer with a strange sensation from underneath, in the saddle area.

The following day her pain continued and she suffered with difficulties in urinating. She could not feel the sensation of urinating. She sought emergency help and attended her local A&E.

An MRI scan was urgently arranged and she was diagnosed with Cauda Equina Syndrome. She underwent emergency surgery but was left with ongoing pain, numbness to her right thigh and difficulties with urinating.

Unfortunately the delay in referring her to hospital resulted in a delay in diagnosis of Cauda Equina and treatment. Had treatment been received sooner such symptoms like right thigh numbness and urinary problems would have been avoided.

Jennifer was properly compensated for these life-changing consequences.