Cauda Equina Syndrome Explained
Cauda equina syndrome (CES), a rare disorder affecting the bundle of nerve roots at the lower (lumbar) end of the spinal cord, is a surgical emergency.
It occurs when the nerve roots are compressed and paralyzed, cutting off sensation and movement. Nerve roots that control the function of the bladder and bowel are especially vulnerable to damage.
If patients with CES do not get fast treatment to relieve the pressure by a discectomy, which is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord, it can result in permanent paralysis, impaired bladder and/or bowel control, loss of sexual sensation, and other problems.
Cauda Equina Syndrome Explained
CES Claims Solicitor, David Dickie, explains how it may be helpful to separate the problems that might occur in a patient with a central disc prolapse into five groups:
1. Back/referred or unilateral radicular pain – back pain only or back pain plus referred pain and/or unilateral radicular pain (and/or unilateral radicular sensory disturbance, motor weakness or loss of a reflex). This might be called “CESO”, no (O) increased risk of CES.
2. Bilateral radicular problems – bilateral radicular pain (and/or bilateral radicular sensory disturbance, motor weakness or loss of reflexes). Patients with bilateral radicular leg pain do not have a cauda equina syndrome at that time, but they are at increased risk of developing a cauda equina syndrome. This has been called CESS although perhaps more properly, it should be termed “CES risk”. It has been recommended that MR imaging should take place within twenty-four hours
3. CESI – the incomplete syndrome (CESI)where there are subjective symptoms or objective signs of a cauda equina syndrome but the patient retains voluntary control of micturition. Broadly, patients who are treated when they are CESI do well, exactly how well depends on the specific nature of the problems that the individual patient has at the time of treatment.
4. CESR – the cauda equina syndrome with neurogenic retention of urine (CESR). Such patients have objective signs of cauda equina dysfunction and crucially they have a paralysed insensate bladder, i.e. they no longer have executive control over bladder function. The bladder continues to act as a passive store of urine. When bladder capacity is reached there is reflex contraction of the bladder with incontinence. When one reviews the medical literature in this area there is uncertainty as to whether prompt decompressive surgery after CESR is usually associated with recovery of function, or not.
5. CESC – the complete cauda equina syndrome (CESC) where there is complete loss of all cauda equina function. There is perineal anaesthesia, there is a paralysed insensate bladder, there is a paralysed insensate bowel and the anal sphincter is patulous. This ultimate stage of CES is associated with a very poor prognosis regardless of treatment. Not all patients with CES progress smoothly through these different stages. The speed at which any given patient deteriorates, for example, to CESI or CESR is very variable.
Cauda Equina Syndrome – The Details
The nerve roots of the cauda equina contain axons (nerve fibres) which are of different sizes and whose cell bodies lie in different positions. Motor fibres tend to be large or medium sized axons; sensory and autonomic axons are typically of a smaller diameter. Smaller fibres are less heavily myelinated and they tend to be more susceptible to compressive injury.
Following compression there can be regeneration of injured axons. Regeneration is more likely to occur if compression is distal rather than proximal to the cell body (because where the cell bodies lie distal to the lesion, as do the parasympathetic neurones that lie in the pelvis, regeneration cannot occur if the cell body is irreversibly damaged). In any individual cauda equina axon (or group of axons) we cannot say to what extent the lesion is severe nor to what extent the lesion might be wholly or partially capable (or incapable) of regeneration. Regeneration is more likely to occur where the duration of compression is short, less likely to occur with prolonged compression. It is generally accepted that structural and functional losses in CES occur in a continuous and progressive manner.
How We Can Help
For over thirty years Solicitor, David Dickie, has specialized in this area and achieved substantial settlements for clients as a result of successful litigation. For more information on pursuing a claim, please contact David on freephone 0800 011 6666 or via email at d.dickie@timms-law.com.
