Journal highlights concerns over mismanagement of Cauda Equina Syndrome 6 Aug 2017

Cauda Equina Syndrome is a little known and rare medical condition which arises due to increased pressure around the lower spinal cord. It has several different trigger causes and may be experienced by the sufferer in a number of ways, with symptoms such as:

  • Lower Back Pain
  • Numbness
  • Leg Weakness
  • Impaired bladder, bowel or sexual function

These symptoms can come on rapidly, or gradually over weeks. If left unrecognised and untreated, Cauda Equina Syndrome can have a devastating life-long impact. Over the years, mismanagement of this condition has lead to litigation against NHS Accident and Emergency Departments, General Practitioners and Inpatient Management Teams. The internet and newspapers regularly publish new stories about people who, through clinical negligence, have been left with long term problems arising from untreated Cauda Equina Syndrome. One such case was discussed in the July 2017 edition of the Medicolegal publication Casebook.

A Case in Point

The piece in Casebook outlines the story of a 42 year old builder who presented to his GP with a short history of back pain. He was initially prescribed pain relief and referred for physiotherapy. However over the following months his pain persisted and become so severe that he required ambulance admission to the Accident and Emergency Department, from where he was discharged with the muscle relaxant diazepam.

Over the following days, his pain increased to greater severity and he developed problems with urination. The area around the top of his legs became numb. Further GP assessment resulted in pain relief being prescribed once more. It was not until the pain became excruciatingly unbearable and he was finally examined under MRI, that the diagnosis of Cauda Equina Syndrome was correctly recognised and treated.

However, the delay in diagnosis and treatment meant that he was left with long term neurological problems including bowel, bladder and sexual dysfunction. He brought a claim against the medical teams involved. Experts concluded that the case was indefensible and it was settled for a high sum, raising the question: What price can adequately compensate for this life-long, yet highly preventable injury? It would be very hard to put a figure on it, although the courts do try.

The Cost of NHS Clinical Negligence

So while the personal cost of clinical negligence is unquantifiable in terms of suffering and reduced quality of life, it is easier to gauge the financial cost to the NHS. In fact, the total annual cost of claims against the NHS has risen to £1.5 billion and is projected to increase to £2.6 billion over the next five years. Raising the awareness of this devastating condition within the general public and the medical spheres can only benefit patients as well as the public purse.

So the Message is: Publish and Inform

The role of the internet and newspapers in educating the general public about the risks of Cauda Equina Syndrome is key. An informed patient cannot be palmed off when they are suffering from severe and unremitting symptoms that cannot be properly explained and are not being adequately treated.

The role of medical journals includes educating healthcare professionals and reminding them that they should keep a low threshold for reassessment if symptoms persist or change. Ultimately and in an ideal world, Cauda Equina Syndrome will soon be consigned to history.

Ben Posford, partner and head of serious injury claims at Osbornes is regularly instructed to act for claimants with Cauda Equina Syndrome. He is recognised in the independent legal directories, Chambers UK  and The Legal 500, as a leading expert catastrophic injury lawyer in London. To speak with Ben you can contact him on 020 748 58811 or by e-mail to

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