The cauda equina are a bundle of nerves at the base of the spinal cord. They control lower limb sensation and pelvic functions.
When these nerves become compressed, it can result in a very serious condition called cauda equina syndrome (CES).
There are many causes of the syndrome, the most common being a slipped/prolapsed/herniated disc pressing on the nerves, but it can also result from a traumatic injury, spinal stenosis (an abnormal narrowing of the spinal canal), spinal tumours, inflammatory conditions, infections or medical accidents during surgery.
Whilst the condition is rare – between 1-3 people in every 100,000 people suffer from CES, and 1-2 people in every 100 with a slipped disc – the symptoms should be diagnosed and treated quickly by medical professionals.
If the nerves are not decompressed via surgery within 24-48 hours of the onset of symptoms they can become permanently damaged with devastating – and sometimes lifelong – consequences.
Why Cauda Equina Symptoms Are Commonly Misdiagnosed
One of the most typical symptoms of CES is severe lower back pain. As such, it can often be misdiagnosed as another common back complaint. Patients may even be sent away from the hospital or GP surgery with no further investigations, meaning they regularly miss the vital time window in which to decompress the nerves.
However, not all sufferers experience back pain.
Other symptoms associated with cauda equina syndrome include:
- loss of sensation in the lower limbs, or weakness or pain in one (unilateral) or both (bilateral) legs
- reduced lower extremity reflexes
- numbness of the buttocks or groin area
- loss of genital sensation
- problems with bladder and/or bowel control (constipation or incontinence)
- loss of sexual function.
These are what are known as ‘red flag’ symptoms of the condition, which should prompt the doctor to immediately organise the tests required to diagnose the condition.
These symptoms usually come on very quickly, which should be another indicator to the doctor that it could be a case of CES.
The reason that the condition is so frequently misdiagnosed is that most people suffering from a combination of these symptoms won’t actually have a critical compression of the cauda equina – in fact just 10% of people presenting to the doctor with these symptoms will actually have CES. Most will be suffering from a different condition which has similar symptoms.
Nevertheless, due the potential severity of the damage which can result from this condition, doctors should always be cautious and have a low threshold for requesting further investigations just in case it is a case of CES.
How Cauda Equina Syndrome Is Diagnosed
Once a patient has presented with these symptoms, several physical and neurological tests should be conducted in order to accurately diagnose CES. These may include:
- assessment of spinal alignment, stability and range of motion
- testing of senses – reflexes, sensation, strength and balance
- evaluation of the anal sphincter muscle for damage related to bowel problems
- imaging tests including X-ray, MRI, CT and myelogram – a real-time X-ray where contrast dye is injected to evaluate nerve damage
- blood tests.
The doctor will also take a full medical history, especially with regard to any recent trauma, infections or even cancer diagnoses.
Unfortunately, because the symptoms are associated with many other often less serious conditions, many people are not referred for these tests either quickly enough or even at all.
The Consequences of Cauda Equina Symptoms Not Being Taken Seriously
If your treating doctor does not recognise the red flag symptoms, conduct the relevant tests, and send you for urgent decompression surgery within the critical 24-48 hour time window, the results can be devastating.
The nerves may now be irreparably and permanently damaged.
This can result in:
- altered lower body sensation
- problems with leg function and mobility, which could even be as significant as lower body paralysis
- continued bladder and bowel problems
- sexual dysfunction
- continued severe back pain.
Due to the irreversible nature of the damage, all you can do is learn to manage and live with the symptoms. Various therapies such as physical, occupational, sexual and continence advice can help to improve your quality of life.
Seeking Compensation to Help Manage Your Condition
If you are able to prove that you were a victim of a misdiagnosis or that your diagnosis was delayed which meant you were treated too late, you may be entitled to make a claim for compensation.
Coles Miller Partner and Head of the Medical Negligence Department David Simpson is a specialist in Cauda Equina claims. He has successfully secured hundreds of thousands of pounds of compensation for misdiagnosis victims in order to help them rebuild their lives and manage their condition as best they can.
If your CES was misdiagnosed or you received a delayed diagnosis, book a free chat with David today. He is committed to securing proper and appropriate compensation for those unfortunate enough to have been injured due to the negligence of members of the medical profession.
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