Successful claim after hospital's failure to act on early diagnosis of Cauda Equina Syndrome

We have recently settled a claim for a woman who suffered a lumbar slipped disc in her early 20s, which had been treated conservatively at the time with physiotherapy to achieve a full recovery, but some 20 years later she began to experience pain and stiffness to her back. Over the next few days, the pain intensified and she experienced a stabbing sensation in her thigh and a tingling to her heel, at which point her sister took her to A&E. She was discharged without having any X-rays or scans taken.

When our client’s pain increased the following day, she attended her GP surgery and was referred for a lumbar X-ray.

Some five days later, her right heel, right thigh and right buttock had gone numb and she returned to A&E. No neurological examination was carried out and although good anal tone was noted, our client recalled that at that stage, the perianal area was numb.

She was again discharged and it was not until two days later when she vomited and felt a popping sensation in her lower back, that she was finally admitted to hospital after attending  A&E again.

Following a diagnosis of Cauda Equina Syndrome (CES), and despite initial indications that a micro-discectomy would be performed within 12 hours of admission, surgery did not in fact take place until just over 72 hours after she was admitted to hospital.

CES occurs when a spinal disc prolapse presses on the delicate nerves which control the bladder, bowel and genitalia. If left unchecked and untreated, nerve damage occurs which leads to paralysis of the bladder and no executive control which in turn leads to overflow incontinence. It is therefore important to carry out surgery to decompress the lumbar spine as soon as possible.

Although clinical opinion at the time stated that surgery should take place within 48 hours of the development of symptoms of CES, the ‘Standards of Care’ report published by the Society of British Neurological Surgeons lists the neurological ‘red flags’ of back pain, motor weakness to the legs and sensory loss. The report leaves no room for doubt that if an initial diagnosis of CES is confirmed by MRI scan, the patient should be sent to the neurosurgical unit directly and the unit informed, with decompression surgery to be carried out immediately.

While immediate surgery may not be feasible given the potentially life-threatening conditions which have to be dealt with in surgery as a priority, our client was not treated as an emergency case. She was not kept ‘nil by mouth’ to allow for surgery to take place as soon as possible, neither were any initial steps taken to transfer her to an alternative hospital for treatment.

As a result, the treatment of our client’s condition was not as successful as it is likely to have been had her condition been treated expeditiously. She has therefore been left with double incontinence, a loss of sexual function and depression.

Our client’s case was settled for a significant sum following negotiation with the defendant hospital.

The case was led by John Kyriacou, a partner in the clinical negligence team in London. 

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