L EGAL I S SUE S
Tackling errors in Cauda Equina diagnosis
Maya Sushila warns that misdiagnosis of cauda equina syndrome often results from problems with communication, between clinicians and patients, and the cost of subsequent litigation to the NHS can be high.
Thursday 1 October 2020 saw the first annual cauda equina syndrome awareness day. Cauda equina syndrome is a rare condition that affects a group of nerve roots located at the bottom of the spinal cord. Failure to spot a ‘red flag symptom’ and get the right treatment (usually within 24-48 hours) may result in the progression of the condition, including chronic pain, loss of bladder control and the need to use a wheelchair. In this article, Maya Sushila shares that misdiagnosis of cauda equina syndrome often results from problems with communication between patients and their clinician, and she calls on NHS Trusts to support the need for improved recognition of this devastating
condition. While, traditionally, attention has been given to building awareness of this condition among GPs, with increased GP appointment waiting times and painful symptoms, it is pertinent that ambulance staff, A&E consultants and neurosurgeons also are reminded of the ‘red flag symptoms’. Prompt recognition and diagnosis of cauda equina syndrome is dependent upon clinical assessment, including a thorough history and description of the symptoms along with imaging, usually an MRI scan. If left undiagnosed for just 24-48 hours, the condition can have life-changing effects. While patients may feel uncomfortable discussing intimate symptoms with clinicians, delays in treatment and surgery
can lead to less than optimal outcomes for the patient and a significant compensation claim of between £200,000 to £2 million against the NHS.
About Cauda Equina Syndrome Cauda equina syndrome is a rare condition that affects a group of nerve roots located at the bottom of the spinal cord, between the L1 – L5 vertebrae of the lower back. The cauda equina nerves (from Latin, ‘horse’s tail’) has an important function controlling the sensory input and output of the bowels, bladder, pelvic area and controlling lower limb function.
Cauda equina syndrome is caused when the cauda equina nerves are compressed inside the spinal canal, usually at the L4 level or below. The onset of cauda equina syndrome can be the result of the following: l Slipped disc. l Trauma. l Complications following spinal surgery. l Spinal Tumour. l Spinal abscess.
Cauda equina syndrome typically occurs more often in adults than in children. Individuals with cauda equina syndrome will suffer from compression of these spinal nerve roots, which tend to be categorised by a number of symptoms that are referred to as ‘red flag’ symptoms. These symptoms can include: l Numbness, pain or weakness in the legs that causes mobility problems.
l Severe lower back pain. l Bladder or bowel problems, including both retention and incontinence.
l An altered sensation in the buttocks, legs, inner thighs, backs of the legs or feet which is severe or becomes increasingly worse.
Cauda equina syndrome is a medical emergency which requires the condition to be diagnosed and treated generally within
APRIL 2021
WWW.CLINICALSERVICESJOURNAL.COM l 25
▲
©LStockStudio -
stock.adobe.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88
