The cauda equina is Latin for ‘horse’s tail’ which describes the collection of nerves at the bottom of the spinal cord. These nerves are particularly vulnerable to injury because they travel beyond the end of the spinal column and therefore lack any protection from it. One of the most serious spinal injuries, cauda equina syndrome, develops if these nerves ever become damaged through compression.
An injury to the cauda equina can have disastrous consequences for the sufferer. In the worse cases it is not unusual for those with cauda equina syndrome to lose the use of their bowel and bladder, the feeling to their genitals and buttocks, and indeed the use of their lower limbs.
Compression of the cauda equina can be caused by a prolapsed disc, a fracture, or even a tumour in some of the rarer cases. The good news is that the effects of cauda equina syndrome can be limited and even reversed provided appropriate and timely treatment is given. However, the window of opportunity is small. All too often patients are not treated promptly and go on to suffer life-long and debilitating injuries as a consequence.
In successful claims of medical negligence resulting in cauda equina syndrome the damages recoverable can be hugely significant, given the catastrophic nature of the injuries sustained. It is easy to see therefore why such injuries are a common source of litigation.
Such cases are not without their difficulties. It can be difficult to spot symptoms of cauda equina syndrome before it’s too late and often there is very little time for doctors to treat those symptoms before they are irreversible.
A good example of this is the case of Zarb v Odetoyinbo (2006). The Claimant had a history of back pain and saw his GP with worsening symptoms. The GP wrote a non-urgent referral letter but just three days later the Claimant had developed cauda equina syndrome. At the time of the consultation with the GP there was no evidence of incontinence or saddle anaesthesia. Further, even if the Claimant had been urgently referred to hospital, it is unlikely he would have been admitted. The GP was found not to have acted negligently in the circumstances.
Patients who go on to develop cauda equina syndrome have almost always had some form of prior problem with that area of the spine. This poses another obstacle to bringing a successful claim. In assessing the extent to which damages are recoverable, it is important for the solicitor to exclude the pre-existing problems, treatment needed for those and any long-term consequences arsing and to focus solely on the problems that have arisen from the cauda equina syndrome. This might not be an easy task, particularly if the pre-existing problems were severe.
We represent many clients who suffer from spinal injuries including cauda equina syndrome. I currently assist in acting for a client with a substantial claim for damages after she developed cauda equina syndrome when her spinal tumour was not treated appropriately. In that case there was a long delay between the client presenting with back problems and eventually being treated. That delay lead to the development of cauda equina syndrome and the terrible permanent symptoms sufferers typically endure. Liability is admitted by the hospital trust but causation remains a live issue. This further demonstrates how difficult these cases are to win.
In another case Oakes v Neninger and Others (2008) the Claimant was successful in his claim for negligence after two GPs and the ambulance service failed to provide timely treatment resulting in the development of cauda equina syndrome. Despite the clear evidence against them, all three Defendants fought the case to trial.