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Spinal Cord Injury

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

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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.

Missed or Delayed Diagnosis of Bacterial Meningitis Worsens Patient Outcomes

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Prompt diagnosis of bacterial meningitis infection is crucial for best treatment outcomes. Death rates from bacterial meningitis are around 10% with up to 1/3 of survivors suffering long-term serious neurological complications. If diagnosed and treated early, most people recover well.

Because the symptoms of meningitis are similar to flu and other viral infections, some physicians may miss the diagnosis and not treat the infection in a timely manner. In some cases where a diagnosis of bacterial meningitis was missed and poor treatment outcomes followed, there may be compensation available to the injured patient.

Meningitis is a life-threatening condition with initial symptoms similar to flu

Acute bacterial meningitis is an infection of the tissues around the brain and/or the spinal cord which causes these tissues to swell. It can result in paralysis, brain damage or death if treatment is not started early. Bacterial meningitis is a serious condition requiring immediate medical attention and treatment. Unfortunately, the symptoms which accompany bacterial meningitis often closely resemble common flu. In both conditions, a person will often suddenly develop high fever, start vomiting and will experience headaches and loss of appetite. Physicians assessing patients who present with these symptoms may rely on the simple fact that common things happen more commonly and fail to consider more serious but unlikely causes of the patient’s symptoms and take steps to test for bacterial meningitis.

Young children and adults with weak immune systems are at a higher risk

Bacterial meningitis can happen to anyone; however, children under 2 years of age are particularly vulnerable to bacterial meningitis. This is because young children’s immune systems are not fully developed yet. Children who do not receive a complete set of vaccinations are even at a higher risk. Pregnant women are at a higher risk of being affected due to their increased risk of contracting listeria bacteria which may cause meningitis. People with compromised immune systems are at increased risk of bacterial meningitis as well. In rare cases, bacteria may be accidentally introduced into the patient’s body during surgery and spread to the spinal cord or the brain, causing bacterial meningitis.

Medical malpractice for missed or delayed diagnosis of meningitis

When a diagnosis of meningitis is missed or delayed and serious complications such as brain damage ensue, injured patients and their families face high costs of care and loss of income. Several cases have successfully been brought against physicians across Canada for failing to consider bacterial meningitis as a potential cause of their patients’ symptoms and initiating prompt treatment. If you or your loved one suffered an injury as a result of the delayed diagnosis of bacterial meningitis, do not hesitate to contact us for a consultation as to whether or not you have a viable malpractice case.

Nerve Regeneration may Restore Bladder Function in Those with Spinal Cord Injuries

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Researchers from Case Western Reserve University School of Medicine and Cleveland Clinic have restored significant bladder function through nerve regeneration in rats with severe spinal cord injuries.

“While urinary control is complex and recovery took several months, it was clear that this primitive function … does possess the capacity to rewire itself…,” Dr. Silver, one of the lead researchers, said.

The study involved pairing a traditional nerve bridge graft with a new mix of scar degrading and growth factor treatments to grow new nerve cells from the thoracic level to the lower spinal cord region.

“We were especially surprised and excited to discover that once a permissive environment was created, a subset of neurons situated largely within the brainstem, which play important roles in bladder function, slowly re-grew lengthy axons far down the cord,” said Dr. Silver.

The researchers are planning to carry out studies of this method in larger animal models before moving to human clinical trials in the U.S.

Read more about this study here

Results from the study were published in the Journal of Neuroscience (2013; 33:10591-606).

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