PI Brief Update

Shouting About Cauda Equina Syndrome - Mehmooda Duke, Moosa-Duke Solicitors

25/06/13. For many years my firm has been specialising in Cauda Equina Syndrome Cases. This year we have made Cauda Equina Syndrome UK our charity of 2013. Cauda Equina Syndrome (CES) is a sometimes unheard of condition. The lack of awareness about this condition in the medical profession is such that the Founder Chair Trustee of the charity, Annie Glover, also a sufferer, has been working tirelessly since October 2011 to bring about awareness. She has visited spinal units all over the country from Edinburgh to Belfast, from Cardiff to Salisbury talking to health professionals.

The consequences of Cauda Equina Syndrome are devastating for the sufferer and as lawyers who have dealt with many of these cases we feel very strongly about raising awareness about how the condition comes about and how it could be avoided.

Whilst it is hard to deliver an exact number due to the different variations of CES, its occurrence can vary from 1 in 33,000 people right up to 1 in 100,000.

The Cauda Equina is found at the lower end of the spinal cord and is often called the ‘horses tail’. This bundle of nerve roots is found in the lumbar area of the spine and CES is caused when these nerves become compressed. Compression can be caused by things like a slipped disc, trauma, narrowing of the spinal canal or pressure from a tumour.

CES doesn’t always just happen. There are, in most cases, warning signs or Red Flag Symptoms which need to be recognised both by sufferers and health professionals. It is the lack of awareness by the latter which leads to medical negligence claims.

What are Red Flag Symptoms:

-Saddle Anaesthesia ( numbness/reduced sensation in the private parts)
-Bladder Disturbance (difficulty in the sensation of passing water)
-Bowel Disturbance (difficulty in the sensation of bowel movements)
-Sexual Problems
-Nerve Root Pain (Back & Leg)

After the onset of CES symptoms there is a small window of opportunity to prevent permanent damage to the patient. However, very often health professionals do not recognise the red flag symptoms and therefore they do not act quickly enough. The failure to act upon the red flag symptoms is what then leads to a delay in diagnosis.

It is the delay in diagnosis which then leads to irreversible damage being caused. For sufferers, this delay in diagnosis can often mean the difference between a normal active lifestyle and one that is riddled with bowel and bladder problems, sexual dysfunction and in some cases mobility problems.

I have chosen to shout about Cauda Equina Syndrome after having witnessed the detrimental and lifelong impact it can have on many patients who have turned to me for help. Whilst compensation can help sufferers to manage and cope with CES, many just want their old life back. They don’t’ want a life unable to know when they need to open their bowel and bladder or pass wind; they don’t want a life where they cannot mobilise properly; they don’t want to have to use a catheter for the rest of their life or manually evacuate their bowels.

A client we worked with recently with CES was left unable to feel parts of her legs and feet which resulted in the permanent use of crutches; an impossible adjustment for someone who was a regular cyclist and enjoyed outdoor activities with her children. In this case it was an A&E doctor who missed the diagnosis and failed to send our client for an MRI scan.

We have other clients who have even told health professionals that they may have Cauda Equina red flag symptoms but they have been ignored because the health professional has never heard about the condition.

One of our clients even showed an ambulance crew a letter from a doctor showing the warning signs. She begged the crew to take her to hospital, but the ambulance crew who had no knowledge of the condition ignored our client’s pleas and left her at home. Her condition deteriorated and the small ‘window of opportunity’ to carry out surgery was lost.

Delays can occur when symptoms are not recognised, MRI scans are misinterpreted, referrals for urgent MRI scans or surgery are not sent or surgery is performed poorly.

The way forward surely has to be a greater awareness of Cauda Equina Syndrome among health professionals. The consequences of missing the condition are devastating.

NHS resources are always said to be limited but surely the costs involved in training health professionals about this condition would be far less than the costs involved in treating sufferers of this condition for the rest of their lives. There is then the additional cost to the NHS in cases where the condition has arisen as a result of negligence.

I know that this lines with up with the view of the dedicated volunteers at Cauda Equina Syndrome UK. Emma Willis from the charity told me that she feels a clearer definition of CES needs to be drawn up so that it becomes more easily recognisable. It was only last year that CES was finally classified as a spinal injury. According to Emma this was a great breakthrough as patients were routinely being sent to the wrong departments for care due to confusion around its categorisation. Emma told me that she feels the lack of research into the condition needs to be addressed, as does the lack of education about it amongst health care professionals and the general public.

Mehmooda Duke is managing director of medical negligence lawyers Moosa-Duke, based in Leicester

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