What is CES-R?
Cauda equina syndrome can develop both gradually or suddenly but, however it develops, surgery before it becomes cauda equina syndrome with retention is widely agreed to be the most important goal for medical practitioners.
What is cauda equina syndrome?
Cauda equina syndrome can develop when the cauda equina nerves at the base of the spinal cord become compressed, possibly due to a herniated disc, inflammation of the spine or other spine-related condition.
The result of the compression can be the deterioration of the functioning of those nerves, leading to the loss of sensation and control in the lower limbs and genital and 'saddle' area. Ultimately, this can lead to urinary and bowel incontinence and sexual dysfunction.
What is CES-R?
Cauda equina syndrome with retention relates to a late stage of the condition where the patient can no longer feel the need to urinate and may not be able to control the release of urine. This is also referred to as complete cauda equina syndrome.
What is CES-I?
Incomplete cauda equina syndrome describes those patients who may have impaired urinary sensation or control - such as an alteration in flow or difficulty and straining during urination - but have not completely lost bladder sensation or control.
These patients may also have impaired sensation elsewhere in the perineal region, and may be numb around the anus with reduced bowel control.
Patients in this group are likely to deteriorate to CES-R as the functioning of the nerves reduces.
Both CES-R and CES-I patients are likely additionally to be experiencing lower back pain and some reduction in sensation or control of the legs and feet.
The impact on timing of surgery
The identification and treatment of CES-I patients as opposed to CES-R patients is felt to be of paramount importance. Research suggests that, when decompression surgery is carried out before the patient loses all urinary feeling (CES-I) there is a far greater chance of recovery of that function, and, indeed, other function in the saddle area.
Once the patient has lost urinary control and sensation, however, surgery may be less successful in bringing about any improvement.
Therefore, carrying out surgery whilst a patient is at the CES-I stage appears to be the key to success and it is therefore vital that an emergency MRI is carried out as soon as cauda equina syndrome is suspected in order to confirm a diagnosis prior to emergency surgery.
Patients with CES-R should still undergo surgery as a matter of urgency and may well benefit significantly from it but there is less evidence of a positive outcome being associated with a specific timeframe.
Medical Negligence
It can be seen that urgent investigation of symptoms is clearly related to the chances of a positive outcome.
If there is an unacceptable delay in the diagnosis or treatment of cauda equina syndrome allowing the patient to deteriorate from CES-I to CES-R, leading to a poorer long-term outcome, the medical practitioners involved may be considered to have provided a substandard level of care.
Glynns Solicitors
Contact Glynns Solicitors if you are suffering with the on-going effects of cauda equina syndrome. We are a team of specialist medical negligence solicitors and would be happy to help you assess the possibility of a compensation claim.
Please call us on 0800 234 3300 (or from a mobile 01275 334030) or complete our Online Enquiry Form.
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