Cauda Equina Syndrome (CES) refers to a medical condition in the lower spine which can result in devastating neurological deficits including, but not limited to, paralysis, foot drop, impotence and a loss of bowel/bladder control. Specifically, Cauda Equina Syndrome occurs when prolonged pressure is placed upon the nerve roots found at the base of the spine. The hallmark sign of Cauda Equina Syndrome is typically an acute loss of bladder control. The loss of control may manifest as an inability to void in the face of an overwhelming sensation to urinate. Conversely, the loss of control may also manifest as an inability to hold urine altogether. Notwithstanding how Cauda Equina Syndrome may first present, any urinary irregularity subsequent to a spinal cord trauma must include an emergent evaluation to determine if Cauda Equina Syndrome is present. The key to preventing permanent injury is the timely diagnosis and emergent medical intervention to decompress the effected nerve roots. Medical studies have concluded that surgical decompression within 48 hours of the onset of Cauda Equina Syndrome gives the patient the best opportunity for a full recovery. Once Cauda Equina Syndrome is allowed to progress beyond 48 hours, the likelihood of a permanent neurological injury increases exponentially with every passing hour without appropriate medical intervention.
Cauda Equina Syndrome occurs when the bundle of nerves in the lower spine are compressed resulting in neurological symptoms. Typically, pressure on the spinal nerves is caused a by either a severely herniated lumbar disc or a collection of fluid, usually blood, around the base of the spine following a surgical procedure. Although the cause of Cauda Equina Syndrome can vary, the treatment is the same -- Alleviate the pressure on the nerve roots as soon a medically possible.
In the situation where Cauda Equina Syndrome is the result of a severely herniated lumbar disc, most often the patient will present to a hospital emergency department with complaints of sudden and severe back pain. What differentiates a patient with Cauda Equina Syndrome verses a non-emergent condition, such as sciatica, is a complaint of urinary dysfunction of either incontinence or retention. A finding or complaint of urinary dysfunction should result in a full neurological work-up including a stat MRI of the lumbar spine followed by a consultation with the on-call neurosurgeon. A confirmed diagnosis of Cauda Equina Syndrome should be treated as a surgical emergency, and surgery to decompress the nerve roots by removing the offending disc material should be performed as soon as medical possible and within 48 hours of the onset of symptoms.
Where Cauda Equina Syndrome is the caused by a post-surgical hematoma on the spine, the diagnosis may be more subtle. Specifically, much like the herniated disc, the hematoma will compress the nerve roots which will result in urinary dysfunction. However, urinary dysfunction may not be easily diagnosed in the surgical setting because the patients are typically catheterized. In such cases, it is incumbent on the post surgical medical team to closely monitor the patient for atypical symptoms such as unusually intense post surgical pain and laboratory results suggestive of internal bleeding. If a hematoma induced Cauda Equina Syndrome is suspected, the patient should undergo a stat MRI of the lumbar spine followed by a consultation with the surgeon. A confirmed diagnosis of Cauda Equina Syndrome should be treated as a surgical emergency, and surgery to decompress the nerve roots by evacuating the hematoma should be performed as soon as medical possible and within 48 hours of the conclusion of the first surgery.
The medical standard of care for any Cauda Equina Syndrome is for decompression surgery to be performed as soon as medically possible, but no later than 48 hours after the on-set of symptoms. Dr. John Kostuik of Johns Hopkins was one of the first the physician researchers who studied the relationship between the on-set of symptoms related to Cauda Equina Syndrome and the timing of surgical intervention. What Dr. Kostuik found was there was little difference in patient outcomes when decompression surgery was performed within 48 hours of the on-set of symptoms. In particular, surgery within 48 hours gave patients the best opportunity to experience a resolution of neurological symptoms post operatively. However, once outside the 48 hour window, there was a significantly greater likelihood that a patients neurological symptoms would not resolve and become permanent. Also, the further a patient got outside the 48 hour window, the less likely the patient would see any improvement of neurological symptoms with decompression. Cauda Equina Syndrome is truly an emergency medical condition that requires competent healthcare providers to act quickly and decisively.
If you have Cauda Equina Syndrome and you believe your condition was not timely diagnosed and/or treated, you should not delay in seeking immediate legal advice. Medical cases involving Cauda Equina Syndrome are subject to a two (2) year filing deadline in Florida. Likewise, most jurisdictions throughout the United States have a shortened statute of limitations for medical negligence cases. The Law Office of Mark A. Glassman, P.A., has represented victims of Cauda Equina Syndrome in claims against hospitals and other healthcare providers in Florida and throughout the United States. In fact, Mark Glassman, Esq., has investigated and/or pursued Cauda Equina Cases in Florida, New York, New Jersey, Pennsylvania, Georgia, Alabama, Indiana, Texas, Michigan, California, Colorado, Utah, Arizona and Oregon. In addition to our experience, we have access to a network of expert witnesses who specialize in the evaluation of Cauda Equina claims. Please contact Mr. Glassman toll free by phone (844-USA-LAWS) or by e-mail (Mark@USALawsuits.com), to discuss your potential claim.