Cauda Equina Sndrome (CES) is the result of the compression of a bundle of nerves in the lumbar region of the spine, often the result of a ruptured disc. Clinical findings can identify all or some of the following problems:
- Compromise of bladder or urethral sensation
- Compromise of rectal and anal sensation
- Difficulty in passing urine
- Retention of urine
- Urinary or faecal incontinence associated with “saddle” anaesthesia
- Decreased anal tone and dribbling incontinence
The sudden onset of severe lower back pain is often the first indication a patient will have of the problem. It is an acute condition which often requires rapid surgical intervention to release the compression on the nerves in order to prevent permanent neurological damage which can lead to incontinence and dropped foot.
Augustus Cullen Law have recently acted for two Plaintiffs who brought successful actions against the Health Service Executive for injuries they suffered as a result of a delay in diagnosing cauda equine syndrome in two separate regional hospitals.
The first case related to a man in his late 20s who injured his back playing football. He attended with his physiotherapist the next day who noted he was complaining of pins and needles in his feet and pin in his calf. He also noted that his ankle jerks and plantar responses were absent. He was referred to his General Practitioner who in turn referred him for an urgent MRI scan. This scan demonstrated a right paracentral disc protrusion. The Plaintiff also noticed that he had developed perineal numbness and a disruption of his urinary flow, and he was advised by his GP to attend the Emergency Department of his local hospital. A diagnosis of suspected cauda equine syndrome was made there and arrangements were put in place for him to be transferred to another larger regional hospital for an orthopaedic consultation. Unfortunately, following his transfer for an orthopaedic review, the Plaintiff was discharged home by another Emergency doctor who did not appreciate that this was an urgent situation that required surgical intervention. The Plaintiff’s symptoms worsened considerably and he re-attended the hospital 2 days later and was transferred to the neurosurgical unit of Cork University Hospital where he underwent emergency surgery to remove the massive disc protrusion in his lumbar spine that was causing the compression of the nerves. The Plaintiff was left with residual nerve damage which affects his bladder sensation, sexual function and plantar flexion.
Negligence was admitted by the HSE in their Defence to the proceedings, though the extent to which the admitted negligence caused the Plaintiff to suffer his injuries was not admitted and would have been contested had the case proceeded to trial. Settlement negotiations were held shortly before a trial date was sought and the Plaintiff settled his case in the sum of €265,000 and his costs, representing a payment in the region of €250,000 for General Damages and €15,000 for future medication expenses.
The second case was more complicated due to the fact that the Plaintiff had a pre-existing back complaint which had required surgical intervention a number of times prior to the development of her cauda equine syndrome. The Plaintiff who was a lady in her late 30s, developed severe lower back pain suddenly while at her home over the weekend. She was attended to by her out of hours General Practitioner who arranged for an ambulance to bring her to her local regional hospital. She was admitted and a spinal x-ray arranged. The Plaintiff noticed that her bladder and bowels were not working and an MRI scan was arranged for the Monday morning but, inexplicably, it was not carried out. The Plaintiff was reviewed on Monday morning by a Consultant Orthopaedic Surgeon, who also discussed her case with the referring GP, and he arranged for an MRI scan to be carried out in a further 2 days’ time. The Plaintiff was extremely concerned about these delays and through the persistence of her partner, arranged for the MRI scan to be brought forward by 24 hours. Following this MRI scan which identified a large disc fragment compressing the cauda equina, the Plaintiff was transferred as an emergency to Cork University Hospital neurosurgical unit where she underwent surgery to remove the disc fragments and decompress the nerves.
The Plaintiff was left with a severe foot drop, perineal numbness and went on to develop severe neuropathic and mechanical back pain. Proceedings were issued against the hospital based on expert orthopaedic evidence from the UK which criticised the delay in arranging for an urgent MRI scan which would have identified the cause of the Plaintiffs symptoms and led to her undergoing emergency surgery much sooner than was the case. It was clear that this would have altered her outcome considerably, though it was not possible to say that she would not have developed some of her current difficulties in any event due to her complicated surgical history.
Liability was admitted by the Defendant and the matter was fixed for trial in July 2015. Shortly before the trial date settlement negotiations were arranged and the Plaintiff settled her case in the sum of €700,000 and her costs which represented the full value of her claim.
09 July 2015