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Cauda equina syndrome is a neurological condition in the lower spine. The nerve roots contained in the cauda equina, a bony structure at the base of the spine, can become compressed, causing pain, alteration of bowel and bladder function, and loss of or deterioration of sexual function.
Delay in diagnosing the condition will often have a disastrous effect on the outcome, but the window to make the diagnosis and to treat appropriately is a narrow one. The Clinical Negligence Team has extensive experience of running these claims, and can maximise your chances of winning them, with our medical knowledge and legal skills, and support you throughout the legal process, ensuring appropriate compensation is paid to you.
Cauda equina syndrome occurs when the nerves in the lower spine have been damaged, usually through being compressed (for example by a “slipped” or prolapsed disc, or more rarely by a spinal abscess). These nerves supply the muscles of the legs, the bladder, the bowel, and the genitals, so any or all of those structures can be damaged. If the nerves can be decompressed by emergency surgery then the nerve damage is reversible, but once the compression has been in place for a period (more than 48 hours is one estimate but the exact period is uncertain) it is likely to become irreversible. Chronic cauda equina syndrome will usually involve long-term pain, loss of sensation, incontinence, and impaired or lost sexual function.
Cauda equina syndrome usually presents with some combination of the following symptoms: lower back pain, sciatica (nerve pain going down the legs), loss of sensation in the feet or legs, “saddle anaesthesia” (loss of, or change of, sensation in the bottom), and incontinence of urine and/or faeces.
If you have gone to the doctor, or A & E, with a combination of the above symptoms, and have been discharged without treatment, it is quite likely that you have had negligent treatment. For your claim to succeed you would then need to show that, if you had been admitted to hospital instead, your condition would have been successfully treated by an operation to decompress the nerves.
Timings are crucial in cauda equina cases, as the “window of opportunity” to treat the condition is known to be quite small, so it will be very important to know when the symptoms came on, and how they progressed.
There will need to be supportive expert medical evidence, both about the negligence in failing to admit you or treat the condition, and in relation to the timing of treatment and whether it would have been effective in reversing the nerve damage.
There are two types of compensation awarded: “general damages” for your pain and suffering and loss of enjoyment of life, and “special damages” for your specific financial losses (past and future).
The most serious outcomes will usually result in awards of general damages in a range between £70,000 and £130,000.
Special damages are of course dependent upon the circumstances of the individual case. For example, if you are relatively young and unable to work because of the condition, your claim for loss of earnings (past and future) may run into hundreds of thousands of pounds. If your home needs adaptation, or you need different accommodation altogether, the costs of that will be recoverable. If you need care, and help with activities of daily living, then that can be claimed for the rest of your life. A claim for special damages can amount to a very high figure in some cases.
The Clinical Negligence Team will always ensure that you receive the maximum amount of compensation which can be obtained, and a sum which will reflect the seriousness of your injury
Richard Coleman acted for Mr H, who was left with permanent damage to his cauda equina nerves, causing problems with mobility, bladder and sexual function, after an alleged negligent delay in evacuating a haematoma he sustained following spinal surgery,
The haematoma was not negligently caused however it was argued on behalf of our client that the consenting process for the original surgery was negligent. Mr H was told for the first time on the morning of the operation that the surgeon carrying out the operation was not the surgeon with whom he had initially discussed the surgery, and also that this new surgeon intended to carry out the surgery in a slightly different way. Whilst on the NHS a patient is not guaranteed a particular surgeon, Department of Health guidance states a patient should be given sufficient time to consider a significant change in their surgery. The Defendant hospital did not admit negligence but did pay Mr H out of Court compensation of £500,000 for his injuries.
Mr C, a male patient aged 60 years, was admitted to Accident & Emergency with acute low back pain. He explained that his symptoms were almost identical to the back pain he experienced eight years earlier when he had a staphylococcus aureus spinal abscess. His medical notes had been lost. Mr C was discharged from the hospital over the weekend and re-admitted as an emergency three days later. By that point he was having difficulty walking due to weakness in his legs, but no bladder symptoms or perianal numbness were noted. Thereafter, still no steps were taken to confirm whether or not there was a spinal infection or control its progress over the next 24 hours until Mr C lost rectal sensation and was not passing urine and complained of numbness in the soles of his feet. Although emergency decompression surgery took place two days after the second admission to hospital, it was too late to obtain a neurological improvement.
The Clinical Negligence Team obtained damages of £300,000 for Mr C
Mr M, a 63-year-old man, underwent multi-level decompression and fusion surgery in his lower spine. He developed Cauda Equina Syndrome after he suffered a dural tear during the spinal surgery, which was not adequately repaired, allowing some nerve roots to prolapse through the defect in the dura (the outer layer of the tissue which protects the spinal cord).. He subsequently experienced incontinence, pain, numbness and foot drop and his mobility was limited. Causation was disputed in relation to some of the injuries, as he had suffered from significant symptoms in his lower spine, and in his cervical spine, prior to surgery. Simon Elliman, Partner in the Clinical Negligence Team won £200,000 compensation for Mr M after hard-fought litigation.