Cauda Equine Syndrome - Medical Malpractice LawyersLEGAL HELPLINE: ☎ 855 804 7125
If you believe you have not received adequate attention from your healthcare provider and have suffered prolonged pain and distress through negligence you should take urgent advice from cauda equina syndrome medical malpractice lawyers who will assist you in making a legitimate CES claim for damages for personal injury. There are time limits and you should not delay.
If you would like free legal advice on cauda equina syndrome compensation settlements from a specialist medical malpractice lawyer just call the helpline or complete the contact form or email our offices and a cauda equina lawyer will call you to discuss your claim with no further obligation. Our lawyers are experienced in trying extensive claims for severe and catastrophic injuries caused as a result of medical malpractice
Cauda Equina Syndrome is a medical emergency and if left untreated for even a short period of time can cause paralysis below the waist, double incontinence and general loss of sensation including diminished sexual response. The condition arises due to pressure being placed on the bundle of nerves at the base of the spine called the caudal equina (whose literal translation from Latin means 'horses tail'). There are numerous symptoms and failure by a physician to recognize this condition and arrange emergency medical treatment can give rise to legal action for medical negligence to claim personal injury compensation.
Cauda equina syndrome is a rare form of potentially catastrophic injury which may result in paraplegia. Cauda equina lawyers often deal with substantial claims valued at many millions of dollars. Cauda equina syndrome (CES) is not a "back problem" but is a form of spinal cord injury which is caused by damage to a bundle of nerves situated at the lower end of the spinal column and may result in:-
- severe pain in the back, buttocks, perineum, genitalia, thighs and legs
- loss of sensation including tingling or numbness in the saddle area
- weakness in the legs
- dysfunction in bladder, bowel, and sexual activities
- incontinence and retention of urine and feces
- impotence and loss of ejaculation or orgasm
- loss of reflexes
Potential Severe Disability
The most common claim made against medical institutions relating to cauda equina syndrome results from delays in diagnosis and failure to note the patients worsening condition and subsequent insensitivity. MRI and CAT scans can both be performed for confirmation of the diagnosis of cauda equina syndrome. [It is worth noting that medical malpractice may also lie with a neurologist who performs an unsuccessful operation which may make matters worse]. The value of the financial award in a claim for medical negligence for cauda equina syndrome can be very substantial especially for younger claimants after taking into account substantial disability and lost earning capacity.
Mr David Markham, chairman of a major medical insurance group, who is also a consultant orthopedic surgeon, urged doctors, health advisers, triage nurses and medical staff in emergency rooms to ensure they were aware of the condition and added :-
"This problem is an acute surgical emergency which occurs when a group of nerves at the base of the spine become trapped. It is an uncommon condition, rarely encountered by most doctors but once suspected it is not a difficult syndrome to investigate. Early diagnosis and urgent action is essential as failure to treat promptly always leaves the patient with permanent, severe, devastating disabilities and the doctor facing potential allegations of medical malpractice which may be difficult to refute."
CES which arises suddenly should always be regarded as a medical emergency which requires immediate surgical intervention to avoid permanent nerve damage that can lead to chronic disability including paraplegia. The most common cause of CES results from a prolapsed disc pressing on the bundle of nerves at the base of the spinal column. CES may be caused by compression including prolapsed disc, spinal injury, chronic inflammatory arachnoiditis, stretching, slippage of one vertebra on another, demyelination and toxic damage due to spinal anesthetics.
Causes of CES
Cauda equina syndrome can happen because of compression of the cauda equina or inflammation of the nerve roots involved in the cauda equina. The symptoms are usually severe; however, they are often temporary and treatable. Some people have symptoms related to paralysis and loss of bowel and bladder function that can be permanent.
The major causes of cauda equina syndrome are traumatic or inflammatory. There are many causes of cauda equina syndrome, some of which are preventable. These include herniation of a vertebral disk, spinal stenosis due to narrowing of the bony spinal canal, spinal tumours or cancers, infectious conditions, accidents caused by medical intervention and inflammatory causes. The cancers that can lead to cauda equina syndrome include metastatic disease, schwannomas, meningiomas and ependymomas.
Trauma as a cause of cauda equina syndrome can include having a back fracture or a subluxation of the lumbar spine leading to compression of the nerve rootlets. Blood can surround the nerves and forms a blood clot that interferes with the blood flow to the nerve rootlets. Penetrating trauma, such as a knife wound or gunshot can damage the vertebra and the cauda equina. Rarely, a chiropractor can manipulate the spine and do damage to the cauda equina in the process.
Disc herniations can cause a spinal problem leading to cauda equina syndrome. Most disc herniations respond well to conservative therapy that includes taking anti-inflammatory medications, doing physical therapy and resting for a couple of days. About one to fifteen percent of all disc herniations result in cauda equina syndrome. Ninety percent of all disc herniations affect the spinal levels of L4-L5 and L5-S1.
Low Back Pain
Those with chronic low back pain are at particular risk for having herniated discs and cauda equina syndrome. In fact, about 70 percent of cases of disc herniation causing cauda equina syndrome come in patients who have had longstanding low back pain and about 30 percent have cauda equina syndrome as the first sign of having lumbar disc disease. It is more common in males and in those in their 30s and 40s. Pieces of the disc fall off and fill up the space within the spinal canal.
Spinal stenosis can cause cauda equina syndrome. This can be something you were born with or that can occur because of degenerative disc disease. If you have spondylolisthesis, or a forward slippage of one vertebra on another, there can be a narrowing of the spinal canal that causes cauda equina syndrome.
Tumours can cause cauda equina syndrome by compressing the space where the cauda equina is located. Most of these are metastatic diseases caused by other types of cancer that have metastasized to bone or to the spinal cord area itself. A person with this condition usually has signs and symptoms specific to the type of cancer they have plus numbness or paralysis of the legs, back pain and bowel or bladder trouble. The back pain can be very severe, depending on the size and location of the tumour.
Inflammatory or infections conditions can cause cauda equina syndrome. Inflammatory conditions commonly causing cauda equina syndrome include Paget’s disease and ankylosing spondylitis, both of which affect the bone. Infections can affect the space where the cauda equina sits, such as with a spinal epidural abscess, which can deform the nerve rootlets and the spinal column. Symptoms of these conditions include severe back pain and muscle weakness that is worsened over time.
There are iatrogenic causes of cauda equina syndrome. “Iatrogenic” means that the problem was caused by a doctor’s mistake. This can include badly positioned screws placed in the spine during spinal surgery. Continuous spinal anaesthesia can damage the cauda equina and a lumbar puncture done to see if someone had meningitis or other medical conditions can cause a spontaneous epidural hematoma that presses on the nerves of the cauda equina, leading to symptoms of cauda equina syndrome.
Damages obtained by cauda equina syndrome medical malpractice lawyers can be substantial particularly in younger victims due to the potential for reduction of earning capacity in addition to damages for pain and suffering. Compensation claims usually arise as a result of inadequate or negligent surgery or as a result of delay in diagnosis and treatment which may worsen the condition often rendering it untreatable. Urgent surgical treatment is usually necessary to restore bladder and bowel function which can prevent further permanent deterioration in the lower extremities. Treating physicians must ensure that they are familiar with the symptoms of this condition and ensure surgical intervention by a competent neurosurgeon at the first possible opportunity.
Symptoms of cauda equina syndrome include having low back pain in some cases, pain in the legs that travels down the back of the legs, a condition called sciatica, numbness in the groin area, bowel and bladder problems, weakness of the legs, numbness of the legs, reduced/absent lower extremity reflexes and radicular pain in the low back. Radicular pain in the low back is a sharp, stabbing type of pain resulting from the compression of the nerve roots. It travels down the leg in sharp pains.
Bladder problems associated with cauda equina syndrome include an inability to urinate, incontinence, decreased sensation of urination or difficulty starting a stream. Bowel problems can be an inability to stop a bowel movement (incontinence of stool), constipation or loss of sensation and anal tone of the anal area.
Low Back Pain
CES does not always arise as a result of an obvious sudden traumatic injury and many patients who are at risk will attend their doctor suffering from relatively minor back ache. To avoid a claim for cauda equina syndrome medical malpractice, there are four vital questions that healthcare professionals should ask patients who are suffering from low back pain. Failure to ask these questions may be an indication of negligence if the condition subsequently manifests itself as problematic late diagnosed or untreated CES.
- Has your bladder been working normally? Can you tell when its full?
- Have you had any loss of control or difficulty passing urine? Have you felt that you want to go all the time?
- Have you noticed any numbness or strange sensations around your buttocks or between your legs?
- Have you noticed any changes in sexual function including loss of feeling in your genitals or not being able to get an erection or ejaculate?
- Have you experienced any unusual problems with your bowels lately?
Doctors need to do a complete history and physical examination in order to diagnose cauda equina syndrome. Tests of rectal tone, sensation of the lower extremities, reflexes and motor strength of the lower extremities are especially important. The doctor can also do imaging studies including an MRI of the low back or a CT scan of the low back, which will show areas of tumour or other narrowing of the spinal canal at the level of the cauda equina. Plain x-ray films of the back can show arthritic changes of the lumbar spine which can mean cauda equina syndrome is present.
The treatment of cauda equina syndrome depends on the cause of the cauda equina syndrome. In some cases, anti-inflammatory medications can reduce inflammation of the nerve rootlets. This can include medications like ibuprofen or naproxen; however, stronger medications like prednisone or Solu-Medrol can be used by IV or IM. These methods can control cauda equina syndrome caused by ankylosing spondylitis or other inflammatory conditions.
Surgical options are also available. Doctors can surgically open up and decompress the cauda equina on an emergency basis. The nerve pressure on the cauda equina needs to be done relatively quickly so as not to permanently damage the nerves. It needs to be done within 48 hours of signs and symptoms of compression of the nerve roots in order to make sure the sensation and muscle weakness aren’t permanent. Some surgical interventions include having a laminectomy, which opens up the passageway of the nerve rootlet, a discectomy, which removes the damaged part of the vertebral disc that is causing compression of the nerve rootlets, and fusion of the spine, which keeps the vertebral column straight and in line.
People with bilateral sciatica have a decreased chance of full recovery than those with single leg pain. Those with complete groin numbness are likely to have permanent bladder paralysis. The extent of the groin numbness determines the outcome of having cauda equina syndrome.
In order to succeed in a personal injury lawsuit against a healthcare profession it is necessary for a medical malpractice lawyer to prove ‘negligence’. To do this an injured person must show that the standard of care provided by the doctor has fallen below an acceptable level that is determined by comparing the doctors behaviour with a group of his peers however the matter is more complicated than appears as, dependent on the status of that doctor, different standards apply. This means that consultants and specialist are expected to apply a higher standard of care than lesser qualified doctors. In 1954 the Supreme Court of Canada stated
What the surgeon by his ordinary engagement undertakes with the patient is that he possesses the skill, common knowledge and judgement of the generality or average of the special group or class of technicians to which he belongs and will faithfully exercise them.
In addition the patient must show that the doctor owed the patient a duty of care which always exists in a doctor/patient relationship, that the duty of care was breached and that harm was caused directly as a result. The mere fact that one treatment fails whereas another may have succeeded does not necessarily imply negligence provided that a substantial body of medical opinion supports the failed treatment.
Cauda Equina medical Malpractice lawyers
Our cauda equina syndrome medical malpractice lawyers can help you to exercise your legal rights to obtain compensation. Our lawyers will deal with your claim using a contingency fee arrangement which means if you don't succeed in receiving compensation then your lawyers won't get paid. You will receive a complete professional service from cauda equina lawyers who specialise in claiming compensation for personal injury caused as a result of clinical negligence. For advice at no cost without obligation just use the helpline or email our offices or complete the contact form and a qualified lawyer will telephone you immediately to discuss your potential compensation claim without further obligation.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here