What is Cauda Equina Syndrome?
Cauda Equina Syndrome or CES is where all of the nerves in the lower back suddenly become severely compressed. It is a neurosurgical and spinal orthopaedic emergency. It can become a progressively serious condition and a fast diagnosis and treatment can be key.
Typical signs and symptoms or otherwise known as red flags include:
- Reduced function in the lower limbs – weakness in extending the knees, ankle and feet
- Difficulty going to the loo and urinary incontinence/accidents
- Loss of sensation and awareness of the need to use the loo, resulting in bowel incontinence/accidents
- Loss of sensation in the perianal, perineal or genital area
- Laxity of the anal sphincter
If not treated in time, CES can have severe longer lasting effects such as:
- Lower back pain
- Bladder dysfunction
- Bowel dysfunction
- Sexual dysfunction
- Genital numbness
- Foot drop
- Mobility problems
These longer lasting effects can have a devastating outcome on your quality of life.
Working environment and common causes
Some of the common causes of CES below:
- a ruptured disc in the lower back
- a narrowing of the spinal canal
- spinal tumour
- haemorrhage or infection to the back
- It can also result from a trauma such as a car accident, gunshot wound, stabbing or a fall
Additionally work environments can come with certain risks and exposures which can lead to CES. In our experience, from working with serving personnel or ex-serving personnel members who have pursued legal claims for a spinal injury, I have seen cases occurring earlier during training or years down the line in a service career. Some examples of cases involving spinal injury or CES which I have come across include a sporting injury, trauma or heavy lifting.
Do I have a claim?
As a Service person, you are owed a duty of care by your Chain of Command and Medical Officers.
In our experience, CES claims mainly arise in two scenarios:
- Training accidents
You may have been tasked with duties or exercises that involve excessive lifting, such as a loaded march. These sort of exercises can result in injury to your spine. Whilst these exercises are part and parcel of military life, the load you are required to carry is sometimes beyond regulations and/or against your medical grading. Your superiors are obliged to consider your fitness to carry out any tasks and assess the risks of injury.
- Clinical negligence
CES is sometimes missed by Medical Officers and we often see cases where a service person has reported to their Medical Centre with ‘red flag’ symptoms, such as incontinence, reduced sensation, and reduced function in the lower limbs. They may be negligent for not referring you for urgent diagnosis and treatment, which may include an MRI scan, neurosurgical referral and decompression surgery depending on the individual case. They will also be obliged to medically downgrade you, so that you are not required to continue to do tasks, which may make your condition worse.
Following diagnosis of CES, a Medical Officer can deem you unfit to serve and medically downgrade you. They may then refer you for a medical board and if the board deems you unfit to serve you may eventually be medically discharged.
What can you do if you suffered CES?
If you were diagnosed with CES and or you are concerned that your treatment was negligent then you may have a potential civil claim.
When a case comes to us at Bolt Burdon Kemp we ask you for a history of your injury/back pain and events leading to CES. We also ask for copies of your medical records if you have these or we can request these on your behalf.
The solicitor will then review all of the information to hand and assess whether your case meets the legal test. To succeed in your claim we must prove the health professional breached their duty normally by failing to treat, diagnose or refer you. Secondly we must prove that ‘but for’ the negligence, you would not have suffered an injury or loss.
Time limits in cases will vary. These are normally taken to be three years from the point of injury. However, in clinical negligence cases this may be three years from the date you should have realised that there was a problem with your treatment. For most of our clients this is often taken from the date that they are diagnosed with CES.
You should always check time limits with a solicitor. If you fail to issue your claim in time you will lose your right to compensation.
You may also be eligible to apply for an award under the Armed Forces Compensation Scheme (AFCS). You normally have to make this claim within seven years of any injury, although applying early is always advisable.
What to do next?
If you have suffered a CES or a spinal injury and have concerns then please contact the military team at Bolt Burdon Kemp for free no obligation advice and consider the avenues for making a claim.