Cauda Equina – when timing is everything in diagnosis and treatment of low back pain

Low back pain affects millions of people and is quite common. Most often, it resolves on its own. In rare occasions, severe back pain can be a symptom of cauda equina syndrome, a serious neurologic condition in which damage to the cauda equina network of nerves causes loss of function of the spinal cord. Cauda equina syndrome can be caused by a variety of medical conditions including herniated disks, tumors, fractures or infections. The most common cause, however, is a prolapsed or herniated disk.

Symptoms of cauda equina include low back pain, bilateral leg pain, “saddle” anesthesia, weakness in the legs, loss of sensation around perineal and/or perianal areas, and bladder or bowel incontinence/retention. This syndrome is considered a true surgical emergency meaning any patient who exhibits the signs and symptoms of cauda equina should be taken to the OR as soon as possible for surgical decompression of the nerves involved. Cauda equina syndrome occurs relatively rarely, but a missed or delayed diagnosis of the condition often becomes the cause of action in medico-legal lawsuits.

Some of the more common examples of medical negligence involving the delayed diagnosis of cauda equina syndrome include the following medical mistakes:

  • failing to complete a thorough medical exam, including checking the rectal tone,
  • failing to diagnose saddle anesthesia by eliciting proper history from a patient,
  • failing to obtain emergency imaging,
  • failing to refer a patient for an urgent consultation with a qualified spine surgeon,
  • failing to recognize bladder/bowel incontinence as absolute emergency symptoms,
  • failing to provide a patient with appropriate instructions as to when to seek emergency help,
  • failing to organize and perform the surgery right away.

Prompt surgical decompression of cauda equina syndrome results in improved patient outcomes. Care providers must view cauda equina syndrome as an absolute emergency that requires prompt diagnosis, consultation and treatment.

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