Causes Of Cauda Equina Syndrome

Cauda Equina Syndrome (CES) is the result of major compression of the whole or part of the cauda equina (the “horse’s tail“ lookalike, a bundle of nerves at the bottom of the spinal cord), causing impairment of the circulation of the nerve roots and failure of nerve function.

This involves the sacral nerve roots but sometimes the lumbar roots also, depending on the level and the completeness of the lesion. There are several compressive lesions which can cause cauda equina syndrome, such as large disc protrusion, haemorrhage, tumour, fracture, abscess, or low back surgery.

Lumber, Lower Back Or Disc Herniation

A lumbar , or lower back , disc herniation may sometimes occur so abruptly and be so enormous that the whole of the cauda equina is seriously compressed. Generally, a disc will protrude into the spinal cord postero-laterally and it compresses only one, or perhaps two, nerve roots at the side of the cauda equina. The disc causes sciatic pain down only one leg in the distribution of the root(s). However, sometimes, either as migration of a large fragment towards the mid- line, or as herniation through the mid-line of the posterior annulus, the compression can be so severe as to involve all the cauda equina. It may be sudden or slowly progressive. The degree of compression will depend on the size of the herniated fragment, and the available space within the spinal canal. The roots within a small stenotic canal are particularly at risk from massive compression.

Post-Operative Haematoma

A post-operative haematoma needs to be excluded as a cause of unexpected neurological compression after surgery because if unrelieved, it can steadily increase and cause a cauda equina syndrome. A patient’s neurological losses noted post operatively should lead to diagnosis and the literature suggests that operating to remove the haematoma and decompress within twelve hours of onset of symptoms, should lead to a full recovery.

Spinal Tumours

Spinal tumours usually develop slowly, so the diagnosis of CES is often late, but normally it is made before the neurological lesion is complete and accordingly a decompression operation can offer some relief.

Abscess

An abscess causing neurological compression in the lumber spine is uncommon , usually diagnosed early and effectively treated.

Fractured Bones

Fractured bones can damage the spinal canal and cause neurological problems requiring surgery.

Causes Of Cauda Equina Syndrome – Clinical Negligence Claims

Clinical negligence claims for substandard treatment sometimes arise from low back surgery. An example might be compression caused by a haematoma or by a surgicelloma, where surgicell is used to try to stop excessive bleeding but itself swells considerably. Or nerve roots can be crushed by surgical instruments, compression can arise from metalwork such as laminar hooks or wires, or from retraction whilst obtaining a good exposure.

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.