Written by

Michael Gray - Partner, Senior Solicitor

Michael Gray, Senior Solicitor recently concluded not one but two cauda equina claims in quick succession, he secured over £3 million in damages to ensure that his Clients can live their best lives.

However, both now live with complex disabilities and care needs after being subject to negligent medical treatment.

What is Cauda Equina Syndrome?

The Cauda equina, or ‘the horses tail‘, is a bundle of nerves at the base of the spine. Over time the nerves can become damaged when compressed and a ruptured disc in the spine is the common trigger of compression. As a result, infections can develop (abscess) and a tumour or stenosis can lead to additional problems.

Symptoms commonly include;

• Bilateral weakness in the legs
• A numb “pins and needles” type sensation in the buttocks and genital area
• Problems passing urine or having sex

Michael says “Cauda equina syndrome is a rare condition that many doctors might go their whole medical career without seeing. Unfortunately, as a medical negligence serious injury lawyer, it is something I see more than I want to. About 10% of my case load are cauda equina injuries and a delay in recognising “red flag” symptoms can be devastating for both the patient and the doctor.

Even the best doctors can’t undo the nerve damage caused by a prolonged delay in diagnosis.

It’s even more life changing for the patient who is likely to suffer with disabling neuropathic pain, bladder and bowel incontinence and sexual dysfunction. Not to mention the fact that they’re likely to struggle to hold down paid employment and the strain that puts on their relationships.”

What are the symptoms?

Whenever a patient presents with “red flag” symptoms then it’s time for urgent action. To identify the source of the problem, neurosurgeons recommend a full examination and an MRI.

After that, decompression surgery should quickly follow within 48 hours so any damage can be assessed. The length of delay impacts the extent or permanence of the damage. Patients with bladder problems may find themselves having to use incontinence products such as pads or catheters.

Furthermore, Patients with bowel problems may need to use an irrigation system.

Michael explains further “It’s a real lifestyle adjustment and clients need psychological support as well as equipment, physical care and support. The clock can’t be turned back and the damage can’t be undone. What we can do is make sure that seriously injured patients have the right care, support and living arrangements to make the most of the function they have left.”

K’s cauda equina experience

At the age of 27, “K” underwent spinal surgery to relieve persisting back pain. Unfortunately for K, her doctors failed to confirm her MRSA status before operating. K was MRSA positive and contracted an infection through the surgery site. This then led to a spinal abscess which compressed the cauda equina. The compression went untreated before she developed cauda equina syndrome.

To this day, K still suffers with the above symptoms.

She has since retired from her NHS job as a Community Healthcare worker on medical grounds. Now K requires extra help caring for her young child.

K approached Patient Claim Line to act on her behalf.

Initially the claim was in pursuit against the NHS Trust, a GP and the GP Practice.

This is where the crucial MRSA results are sent. Neither the GP with results in hand, nor the Practice Staff took action to communicate the important results to the Hospital who then failed to check for the missing result before surgery. Because of this, it took years to reach an agreement on liability. The Hospital Trust agreed to try to settle the claim and put right what they admitted they had done wrong.

After mediation broke down without an agreement, the parties continued to talk. In the weeks that followed, there was agreement for a lump sum of £1.85 million. A Periodic Payment Order was one consideration, but a clean break was the preferred outcome for this client. K has since gone onto purchase a bungalow which is much more suitable to her needs than her current rental property. She has also employed a case manager to put in place care and support arrangements.

D’s cauda equina experience

“D” is another case of Michael’s that began with back pain.

As a result of the pain, D was unable to work for a number of years and was keen for a fresh start. However, before D could think about starting an IT training course he developed “red flag” causa equina symptoms. Michael’s case argues there should also have been sufficient concern to arrange a same day MRI. If that happened, it would have resulted in emergency surgery. In Michael’s case documents, there was debate around the MRI and when exactly the surgery should have taken place.

The debate remained unresolved right up until settlement.

D suffered from bladder, bowel and sexual dysfunction with a more complex rectal pain which further surgery failed to improve. In fact, it made it worse making a stoma much more likely in the future. The parties planned a joint settlement meeting to take place after the exchange of medical evidence. After some negotiation there was an agreement for a lump sum of £1.25 million as a settlement. Since the case, D is looking for a bungalow of his own close to his children’s school.

D’s partner also plans to retrain as a carer to provide for his more intimate longer term and support care needs. These are just two examples of the impact of not following protocol and failing to act upon “red flag” symptoms. It’s no surprise that medical defence organisations issue reminders and specific guidance to their members about recognising the “red flag” symptoms.

What are the guidelines on cauda equina syndrome?

The NICE guidelines make sure that those requiring urgent investigation receive a referral, the right assessment and the necessary treatment in a timely fashion.

NICE also break down the core red flag areas of the syndrome on their website.

Michael concluded “Recognising the warning signs doesn’t have to be difficult. It’s a checklist and the risks can be minimal. Doctors should have cauda equina in mind when faced with a patient with sciatica. They should take the time to listen to their patients and realise that people don’t always articulate the crucial “red flag” symptoms as you’d find them in a textbook. It’s really frustrating for me as a lawyer to read a set of medical records and to see doctors overlooking crucial symptoms. Or worse, documenting that “red flag” safety net advice has been dispensed when the patient in front of them is exhibiting those symptoms that they are being told to watch out for.

Not every cauda equina case is a medical negligence case.

Sometimes, despite everything – the damage is done.

I am hopeful that one day soon I will see fewer cauda equina cases but I’m sorry to say that we have not reached this point yet.”

If you have received a delay in your Cauda Equina Syndrome diagnosis then please click here to start your claims process

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