Cauda equine syndrome (CES) occurs when the nerves at the end of the spinal cord are compressed. The condition creates a medical emergency that requires immediate surgical intervention. The patient can develop adverse complications without treatment including neurological and physical conditions like an impaired bladder, loss of bowel control, paralysis, and challenged walking. While the equine syndrome produces obvious signs and symptoms, many doctors fail to accurately diagnose the condition, which could lead to death.
Rosenfeld Injury Lawyers LLC represents victims of medical malpractice and other types of professional negligence. Our law firm has successfully prosecuted cases for our clients who suffer from cauda equine syndrome (CES) caused by the negligent actions of others. Our attorneys are available to answer any legal questions on how to receive the monetary compensation you deserve if your injuries were a result of a medical mistake or error. Should you have additional questions, we invite you to contact our office for a free review of your legal rights.
What is Cauda Equine Syndrome?
This rare disorder develops with the compression of spinal nerve roots called cauda equine (horse tail) near the base of the spinal column (lumbosacral spine). This area of the spine transfers messages from the brain to the pelvic organs, legs, and feet. If the nerve roots become inflamed or compressed, the patient often experiences:
- Decreased strength
- Diminished sensation including numbness in the legs, feet, sciatica, perineum, inner thighs, and buttocks
- Altered reflexes
- Lower back pain
- Bowel and bladder incontinence
- Muscle weakness
Some patients experienced a delay of symptoms which can make an exact diagnosis challenging, especially for those confined to a wheelchair, bed, or chair.
What Causes Cauda Equine Syndrome?
Most individuals who developed Cauda equine syndrome have experienced a severe herniated (ruptured) disk in the lumbar region. However, there are other causes of the syndrome including:
- Abnormal malignant growth (tumor – neoplasm) that can easily spread (metastasize) to other areas of the body including the breast, lungs, and prostate
- Spinal lesion
- Spinal stenosis for the spinal canal narrows
- Spinal inflammation, infection, fracture, or hemorrhage
- Inflammatory-associated conditions including ankylosing spondylitis (arthritic information that affects large joints and the spine), Paget's disease (a disrupting disease when old tissue is replaced with new tissue) and spinal canal narrowing
- Severe trauma-associated lumbar spine injury complication involving a stabbing, gunshot, fall, or crash
- A congenital disability that involves an arteriovenous malformation development or other abnormal connection of blood vessels.
- Osteoporosis-associated vertebral fracture or spinal stenosis
- Epidural hematoma-related nerve damage caused by a collection of blood due to compression of the cauda equine
- Lumbar spine subluxation (partial dislocation)
- Iatrogenic medical causes including:
- Improperly positioned screws in the spine,
- Continuous spinal anesthesia
- Spinal tap (lumbar puncture) in patients receiving anticoagulant medications
Do I Have Cauda Equina Syndrome?
Many of the signs and symptoms associated with cauda equina syndrome mimic other conditions. The most common symptoms associated with CES include:
- Intense back pain
- Sciatica problems including pain occurring on one or both sides
- Bowel and bladder dysfunction caused by anal and urinary sphincter problems
- The absence of an Achilles (ankle) reflex on both ankles
- Difficulty walking
- Paraplegia and other lower leg muscle conditions caused by weakness
- Detrusor weakness caused by residual incontinence and urinary retention
- Sexual dysfunction
Doctors will often treat CES through surgical procedures to restore nerve function before the decompressed condition causes irreversible damage, permanent paralysis, bowel, and bladder control problems, and other serious medical conditions. Typically, surgery is recommended within the first two days after the onset of common symptoms. The doctor might also prescribe heavy doses of corticosteroids that can reduce tissue and nerve swelling along with antibiotics.
If a tumor is present and causing the problem, the doctor might recommend the patient undergo chemotherapy and radiation treatments after their surgery. Even if the treatment is highly successful, the patient rarely regains full function of their spinal column and may suffer from impaired bowel and bladder function control for many years.
Many patients live with the side effects of cauda equina syndrome because the surgery was unable to repair the condition. To manage chronic CES, the patient must learn to adapt to the many changes associated with multiple body functions. Additionally, the individual likely needs physical, mental, and emotional support from family members and professionals including physical/occupational therapists, continence advisors, social workers, and sex therapists.
Patients who have CES-associated bowel/bladder function problems may have to adapt to manually emptying their bladder up to four times every day. This may require:
- Using a urinary catheter to empty the bladder completely
- Drinking plenty of fluids
- Following an effective personal hygiene regimen to avoid urinary tract infections
- Checking for waste and clearing the bowels manually using an enema or glycerin suppository
- Preventing leaks by wearing protective pants and pads
How do I Know if I am at Risk for CES?
Unfortunately, medical science has yet to determine specific risk factors involved in the development of cauda equina syndrome. However, those most at risk for the condition may have experienced disc herniation through a medical condition, or a traumatic impact from a crash, collision, fall, or another injury. There are a few influential factors that might be involved in developing CES that include:
- Men tend to develop cauda equina syndrome more often than women
- Individuals over 35 years old are more likely to develop CES compared to other age groups
- African-American men and women are less likely to suffer from cauda equina syndrome compared to other ethnic groups
- Heavy lifting is associated with the increased risk of CES
An early diagnosis by a competent physician can prevent cauda equina syndrome by identifying some of the known symptoms including leg weakness or pain A vigilant doctor can easily detect CES and take appropriate measures – usually surgery – to minimize damage and begin the healing process.
According to the National Institutes of Health, approximately 2% of all patients suffering from slip discs (herniated lumbar discs) will develop CES and more than seven out of ten patients will eventually develop unacceptable urologic function that is often associated with chronic back pain. Only one in five patients with cauda equina syndrome will face an unwanted outcome that will require sexual dysfunction management, ongoing treatment, colostomy, self-catheterization, gynecological surgery, urological surgery, spinal injury rehab, and physio-social support.
Medical Malpractice Implications of CES Related to Spinal Anesthesia
A rare complication of spinal anesthesia is CES, especially in patients on anticoagulation therapy. A 1997 report indicated that spinal anesthesia administered through a small gauge needle was associated with CES. If a patient who has received spinal anesthesia complains of back pain, doctors should take steps to rule out CES. Close surveillance can help prevent lasting problems. (See " FDA Safety Alert: Cauda Equina Syndrome Associated with Use of Small-Bore Catheters in Continuous Spinal Anesthesia.")
Unfortunately, in some cases, doctors are too slow to react to a patient's symptoms, either because they minimize the importance of back pain or fail to distinguish normal symptoms from abnormal symptoms. In these situations, surgery may come too late, resulting in permanent nerve damage.
At this point, the patient's only option is to engage in physical therapy, occupational therapy to improve activities of daily living, and learn coping mechanisms to be more independent. Therefore, it is important for doctors to take a detailed medical history and perform a physical examination. An MRI can be used to help diagnose CES because it shows the soft tissue.
Can I Wait to File a CES Claim for Compensation?
No, waiting to file could create serious legal issues. Time is of the essence. Like all personal injury cases, medical malpractice and lawsuits are subject to restricted time limits according to State law. An injured party must file a claim before the statute of limitations expires, which in Illinois, is two years from the time the medical error occurred. Not filing promptly before the statute expires could cause the injured party to lose their chance to ever file a claim at any time in the future.
However, there are some exceptions to the law that will extend the date past the statute of limitations, but you would need the help of an experienced personal injury attorney to calculate how much time you have left. Some common exceptions to the statute of limitations include:
- The injured party is mentally incapable of filing a claim without assistance.
- The victim was 17 years old or younger when the doctor's negligence caused their injuries. In these cases, the law typically extends the legal limitation to three years past their 18th birthday, meaning the case must be filed before the 21st birthday.
- The injured party was unaware that negligence caused their injuries until after the statute had expired.
Rarely do attorneys base their cauda equina syndrome lawsuit on the first to exceptions. However, many CES claims for compensation are based on the third exception when their client was unaware that negligence by the medical team or hospital causedf their injury.
Building a Medical Malpractice Claim
Attorneys working on behalf of their client will often build a cauda equina syndrome lawsuit against primary care physicians, therapists, emergency room doctors, nurses, and the hospital claiming negligence and medical malpractice. In most cases, the doctor failed to diagnose the patient's condition promptly before CES can cause irreparable harm.
The attorney might be able to show the jurors that the emergency room medical team was working in chaotic conditions and provided the plaintiff with unacceptable substandard care that led to the injuries. The doctor may have failed to diagnose a spinal cord compression or other neurological symptoms that would have identified the patient's problems. The doctor may not have ordered an MRI, x-ray, or other image scanning that would have identified spinal cord damage.
The doctor could have confirmed CES using radiology and neurological testing including NCV (nerve conduction velocity) and EMG (electromyography) that would have identified lower back nerve irritation. Any tragic delay in obtaining an accurate diagnosis could lead to a lifetime of pain and discomfort and adjustments needed to accommodate bowel or bladder dysfunction, spinal cord injury, a loss of sensation, sexual dysfunction, urinary tract infections, diminished strength, and muscle weakness.
Chicago Lawyers Helping People With Cauda Equina Syndrome Cases
The medical malpractice attorneys at Rosenfeld Injury Lawyers LLC understand that your medical injuries are not your fault but the result of medical malpractice. We have successfully obtained millions on behalf of the victims and their family members to ensure they were adequately compensated to cover their medical expenses, household bills, lost wages, loss of future earnings, pain, suffering, and emotional damage and we can help your family too. Let us begin working on your monetary compensation case now.
Our legal team encourages you to contact our attorneys today to schedule a free, no-obligation case consultation to discuss the merits of your monetary recovery claim. We accept all personal injury cases, wrongful death lawsuits, and medical error injury claims through contingency fee arrangements. This legal contract postpones the payment of legal services until after we have successfully completed your case through a negotiated settlement or a jury verdict.
Our law firm gets results quickly because we understand you need money now. We probably offer every client a “No Win/No-Fee” Guarantee, meaning if we are unable to secure financial compensation on your behalf you owe us nothing. All information you share with our law office will stay confidential.