Cauda Equina Syndrome Medical Malpractice Lawyer Canada
Cauda equina syndrome is an emergency medical condition involving compression of the spinal cord at the base of the spine. The spinal cord normally runs from the base of the brain until it reaches a point near the first portion of the lumbar spine after which a “tail” of multiple spinal nerves extends beyond the actual cord and exit out various spinal vertebra to innervate the legs and the pelvis, including the rectum. The endpoint of the spinal cord is called the “conus medullaris” and the tail of spinal nerves extending below that point is called the cauda equina. Damage or compression of the cauda equina is called cauda equina syndrome. This condition can have very serious consequences including double incontinence and paraplegia. It is a medical emergency that is frequently not recognised as such by healthcare practitioners. If you have been injured as a result of negligence by a doctor, our specialist medical malpractice lawyers can take action in a court of law to recover damages on your behalf. If you would like to speak about a cauda equina syndrome compensation claim settlement with a specialist medical malpractice lawyer just contact our law offices as soon as possible. We offer free legal advice without further obligation and we deal with substative cases on a contingency basis which means that our cauda equina lawyers only get paid if and when you get paid.
Causes of CES
Cauda equina syndrome can happen because of compression of the cauda equina or inflammation of the nerve roots involved in the cauda equina. The symptoms are usually severe; however, they are often temporary and treatable. Some people have symptoms related to paralysis and loss of bowel and bladder function that can be permanent.
The major causes of cauda equina syndrome are traumatic or inflammatory. There are many causes of cauda equina syndrome, some of which are preventable. These include herniation of a vertebral disk, spinal stenosis due to narrowing of the bony spinal canal, spinal tumours or cancers, infectious conditions, accidents caused by medical intervention and inflammatory causes. The cancers that can lead to cauda equina syndrome include metastatic disease, schwannomas, meningiomas and ependymomas.
Trauma as a cause of cauda equina syndrome can include having a back fracture or a subluxation of the lumbar spine leading to compression of the nerve rootlets. Blood can surround the nerves and forms a blood clot that interferes with the blood flow to the nerve rootlets. Penetrating trauma, such as a knife wound or gunshot can damage the vertebra and the cauda equina. Rarely, a chiropractor can manipulate the spine and do damage to the cauda equina in the process.
Disc herniations can cause a spinal problem leading to cauda equina syndrome. Most disc herniations respond well to conservative therapy that includes taking anti-inflammatory medications, doing physical therapy and resting for a couple of days. About one to fifteen percent of all disc herniations result in cauda equina syndrome. Ninety percent of all disc herniations affect the spinal levels of L4-L5 and L5-S1.
Low Back Pain
Those with chronic low back pain are at particular risk for having herniated discs and cauda equina syndrome. In fact, about 70 percent of cases of disc herniation causing cauda equina syndrome come in patients who have had longstanding low back pain and about 30 percent have cauda equina syndrome as the first sign of having lumbar disc disease. It is more common in males and in those in their 30s and 40s. Pieces of the disc fall off and fill up the space within the spinal canal.
Spinal stenosis can cause cauda equina syndrome. This can be something you were born with or that can occur because of degenerative disc disease. If you have spondylolisthesis, or a forward slippage of one vertebra on another, there can be a narrowing of the spinal canal that causes cauda equina syndrome.
Tumours can cause cauda equina syndrome by compressing the space where the cauda equina is located. Most of these are metastatic diseases caused by other types of cancer that have metastasized to bone or to the spinal cord area itself. A person with this condition usually has signs and symptoms specific to the type of cancer they have plus numbness or paralysis of the legs, back pain and bowel or bladder trouble. The back pain can be very severe, depending on the size and location of the tumour.
Inflammatory or infections conditions can cause cauda equina syndrome. Inflammatory conditions commonly causing cauda equina syndrome include Paget’s disease and ankylosing spondylitis, both of which affect the bone. Infections can affect the space where the cauda equina sits, such as with a spinal epidural abscess, which can deform the nerve rootlets and the spinal column. Symptoms of these conditions include severe back pain and muscle weakness that is worsened over time.
There are iatrogenic causes of cauda equina syndrome. “Iatrogenic” means that the problem was caused by a doctor’s mistake. This can include badly positioned screws placed in the spine during spinal surgery. Continuous spinal anaesthesia can damage the cauda equina and a lumbar puncture done to see if someone had meningitis or other medical conditions can cause a spontaneous epidural hematoma that presses on the nerves of the cauda equina, leading to symptoms of cauda equina syndrome.
Symptoms of cauda equina syndrome include having low back pain in some cases, pain in the legs that travels down the back of the legs, a condition called sciatica, numbness in the groin area, bowel and bladder problems, weakness of the legs, numbness of the legs, reduced/absent lower extremity reflexes and radicular pain in the low back. Radicular pain in the low back is a sharp, stabbing type of pain resulting from the compression of the nerve roots. It travels down the leg in sharp pains.
Bladder problems associated with cauda equina syndrome include an inability to urinate, incontinence, decreased sensation of urination or difficulty starting a stream. Bowel problems can be an inability to stop a bowel movement (incontinence of stool), constipation or loss of sensation and anal tone of the anal area.
Doctors need to do a complete history and physical examination in order to diagnose cauda equina syndrome. Tests of rectal tone, sensation of the lower extremities, reflexes and motor strength of the lower extremities are especially important. The doctor can also do imaging studies including an MRI of the low back or a CT scan of the low back, which will show areas of tumour or other narrowing of the spinal canal at the level of the cauda equina. Plain x-ray films of the back can show arthritic changes of the lumbar spine which can mean cauda equina syndrome is present.
The treatment of cauda equina syndrome depends on the cause of the cauda equina syndrome. In some cases, anti-inflammatory medications can reduce inflammation of the nerve rootlets. This can include medications like ibuprofen or naproxen; however, stronger medications like prednisone or Solu-Medrol can be used by IV or IM. These methods can control cauda equina syndrome caused by ankylosing spondylitis or other inflammatory conditions.
Surgical options are also available. Doctors can surgically open up and decompress the cauda equina on an emergency basis. The nerve pressure on the cauda equina needs to be done relatively quickly so as not to permanently damage the nerves. It needs to be done within 48 hours of signs and symptoms of compression of the nerve roots in order to make sure the sensation and muscle weakness aren’t permanent. Some surgical interventions include having a laminectomy, which opens up the passageway of the nerve rootlet, a discectomy, which removes the damaged part of the vertebral disc that is causing compression of the nerve rootlets, and fusion of the spine, which keeps the vertebral column straight and in line.
People with bilateral sciatica have a decreased chance of full recovery than those with single leg pain. Those with complete groin numbness are likely to have permanent bladder paralysis. The extent of the groin numbness determines the outcome of having cauda equina syndrome.
In order to succeed in a personal injury lawsuit against a healthcare profession it is necessary for a medical malpractice lawyer to prove ‘negligence’. To do this an injured person must show that the standard of care provided by the doctor has fallen below an acceptable level that is determined by comparing the doctors behaviour with a group of his peers however the matter is more complicated than appears as, dependent on the status of that doctor, different standards apply. This means that consultants and specialist are expected to apply a higher standard of care than lesser qualified doctors. In 1954 the Supreme Court of Canada stated
What the surgeon by his ordinary engagement undertakes with the patient is that he possesses the skill, common knowledge and judgement of the generality or average of the special group or class of technicians to which he belongs and will faithfully exercise them.
In addition the patient must show that the doctor owed the patient a duty of care which always exists in a doctor/patient relationship, that the duty of care was breached and that harm was caused directly as a result. The mere fact that one treatment fails whereas another may have succeeded does not necessarily imply negligence provided that a substantial body of medical opinion supports the failed treatment.
Our medical malpractice lawyers offer free initial advice without obligation and thereafter will provide legal representation on a contingency basis. They are experts in handling the most complex medical malpractice claims and they are only interested in representing patients and their families, not insurance companies. They will fight for your legal rights, and ensure that you receive the maximum compensation settlement allowed under the law. Do yourself justice and give us a call.