Cauda equina syndrome: a review of the current clinical and medico-legal position
Cauda equina syndrome (CES) is a rare condition with a disproportionately high medico-legal profile. It occurs most frequently following a large central lumbar disc herniation, prolapse or sequestration. Review of the literature indicates that around 50–70% of patients have urinary retention (CES-R) on presentation with 30–50% having an incomplete syndrome (CES-I). The latter group, especially if the history is less than a few days, usually requires emergency MRI to confirm the diagnosis followed by prompt decompression by a suitably experienced surgeon. Every effort should be made to avoid CES-I with its more favourable prognosis becoming CES-R while under medical supervision either before or after admission to hospital. The degree of urgency of early surgery in CES-R is still not in clear focus but it cannot be doubted that earliest decompression removes the mechanical and perhaps chemical factors which are the causes of progressive neurological damage. A full explanation and consent procedure prior to surgery is essential in order to reduce the likelihood of misunderstanding and litigation in the event of a persistent neurological deficit.
KeywordsCauda equina syndrome Central disc prolapse Bilateral sciatica Urinary retention Perineal hypoaesthesia Sexual dysfunction
The authors are grateful for comments and encouragement from Mr Andrew Ransford FRCS and Dr Bjorn Rydevik.
Conflict of interest
No conflicts of interest are declared.
- 1.Anthony S (2000) Cauda equina syndrome. Medical Protection Society UK Casebook 20:9–13Google Scholar
- 3.Bagley C, Gokaslan ZL (2004) Cauda equina syndrome caused by primary and secondary neoplasms. J Neurosurg Neurosurg Focus 16:11–18Google Scholar
- 4.Bown S (Jan. 2009) Director Policy and Communications, Medical Protection Society (GB), Personal CommunicationGoogle Scholar
- 6.Cohen DB (2004) Infectious origins of cauda equine syndrome. J Neurosurg Neurosurg Focus 16:5–10Google Scholar
- 17.Harrop JS, Hunt GE, Vaccaro AR (2004) Conus medullaris and cauda equine syndrome as a result of traumatic injuries: management principles. J Neurosurg Neurosurg Focus 16:19–23Google Scholar
- 18.Hellstrom P, Kortelainen P, Koamuri M (1986) Late urodynamic findings after surgery for cauda equina syndrome caused by a prolapsed lumbar intervertebral disc. J Urol 135:306–312Google Scholar
- 20.Issada T, Le H, Park J, Kim DH (2004) Cauda equina syndrome in patients with low lumbar fractures. J Neurosurg Neurosurg Focus 16:28–33Google Scholar
- 30.Oakes v Neininger et al (2008) EWHC 548 (QB) (19 March 2008), see http://www.bailii.org/ew/cases/EWHC/QB/2008/548.html
- 34.Ozgen S, Beyken N, Dogan IV, Deniz K, Pamir MN (2004) Cauda equina syndrome after induction of spinal anaesthesia. J Neurosurg Neurosurg Focus 16:24–27Google Scholar
- 39.Shapiro S (1993) Cauda equina syndrome secondary to lumbar disc herniation. Neurosurgery 8:317–322Google Scholar
- 42.Symons R (2008) NHSLA Risk Manager Personal CommunicationGoogle Scholar
- 44.Tandon PN, Sankaran B (1967) Cauda equina syndrome due to lumbar disc prolapse. Indian J Orthop 1:112–119Google Scholar
- 46.The National Confidential Enquiry into Perioperative Deaths (2003) Who operates when? London: NCEPOD 11, see www.ncepod.org.uk
- 47.Uff CE (2009) Clinical assessment of cauda equina syndrome and the bulbocavernosus reflex. See http://www.bmj.com/cgi/eletters/338/mar31_1/b396