Cauda Equina Syndrome

The medical malpractice lawyers at Levine and Glassman, P.A., are experienced representing clients who have suffered serious nerve damage and spinal cord injuries throughout South Florida, including the Miami, Ft. Lauderdale, West Palm Beach area. The attorneys at Levine and Glassman are especially familiar with one serious but rare type of spinal cord injury called "Cauda Equina Syndrome."

What is Cauda Equina Compression Syndrome?

The term "cauda equina" is Latin for “horse's tail” because of the appearance of nerves at the base of the spine.

This bundle of spinal nerve roots are located at the conus medullaris through the first lumbar vertebra (L-1) area going downward from the end of the spine into the buttocks, thighs, rectal sphincter, saddle area and legs.

When the nerve roots are compressed, sensations and movements are restricted which can lead to permanent nerve damage and paralysis.

Symptoms often show up first in bladder and bowel function which are particular vulnerable to nerve damage. In fact, being unable to empty the bladder is considered a "hallmark" symptom of the cauda equina compression. In other cases, the patient first reports symptoms of the loss of sensations and/or burning pain in the saddle region and inner thighs. Often the symptoms quickly transform into extreme pain and loss of movement throughout the hips and legs. By the time the symptoms begin, the damage is already underway. How quickly the doctors act to diagnosis the condition and schedule emergency surgery often dictates the extent of permanent injury suffered by the patient.

Expert Testimony for Cauda Equina Syndrome (CES)

The medical malpractice lawsuit against the physicians and medical centers require the best expert medical and neuro-surgical medical witnesses to testify about the failure to examine and diagnose the patient suffering from cauda equina syndrome (CES). Failing to examine and diagnose CES in a timely manner almost always results in chronic pain, incontinence and impotence. In fact, the delay in diagnosis and scheduling the emergency surgery can lead to permanent disability or paralysis.

Securing the Most Qualified Expert Witness on Cauda Equina Syndrome

The expert testimony on CES is necessary to provide that the standard of care in treating cauda equina syndrome requires immediate and emergency surgical intervention as quickly as possible. The expert must study all available evidence in the case to show mistakes made by the doctor in treating this medical emergency.

Many studies show that patients who undergo surgery within six hours of when the symptoms emerge have the best chance of avoiding long term neurological disability. In many cases, we see a delay of more than 48 hours after the initial hallmark symptoms emerge before surgery is performed. In these medical malpractice cases, that delay in providing the appropriate medical care is the central issue.

Early symptoms of the syndrome can include trouble urinating, weakness in legs, and /or shooting pains in inner thighs, buttocks, hips or legs. In many of these cases, the doctor does not perform a detailed physical examination, including a sensory examination and a rectal examination to determine whether these symptoms are a result of cauda equina syndrome.

What a Medical Malpractice Attorney Must Show in a Typical Cauda Equina Case

In a typical case for medical malpractice when the client suffers a disability after being diagnosed with cauda equina syndrome, the personal injury attorney must make the following types of showings:

• Failure to recognize that the patient's condition was worsening;
• Failure to order appropriate diagnostic studies;
• Failure to consider certain symptoms as being an indication that the patient is suffering from CES (for instance if the patient is suffering from a postoperative hematoma, the fact that the patient is having trouble urinating or overflow incontinence would be secondary to a neurogenic bladder);
• Failure to perform and document a complete and thorough evaluation of the patient including but not limited to a neurological evaluation;
• Failure to follow the progress of the patient;
• Failure to timely diagnose the patient's condition as being cauda equina syndrome;
• Failure to timely treat the cauda equina condition;
• Failure to render appropriate medical care to the patient; and
• Delay in diagnosing and treating post-operative complication of back surgery.

When Medical Malpractice Leads to CES Permanent Disability

Tragically, for many individuals with CES the long terms effects and permanent disabilities that result from the condition could have been avoided with proper medical treatment. When medical malpractice occurs, individuals suffering from CES should contact a personal injury attorney experienced in these specific types of personal injury cases.

Simple tests including an MRI or CAT scan can often show the cause of the symptoms so that the doctor can quickly diagnosis the problem and schedule emergency surgery. However, in many cases, doctors and other health care professions do not perform their job properly which can lead to serious medical complications from a condition like cauda equina syndrome (CES).

Unless the condition is properly diagnosed and treated, then the patient can suffer from permanent sequellae of the cauda equina syndrome which includes incontinence and impotence and other serious medical problems. In fact, the bowel and bladder incontinence that results from CES can cause other medical conditions such infected cysts in the kidneys, hydronephrosis, hemorrhoids and diverticulitis.

Our Solutions for Those Suffering from CES Due to Medical Malpractice

The attorneys at Levine and Glassman know that many people suffering from the effects of cauda equina syndrome were also the victims of medical malpractice. Although this condition is rare, it is relatively easy to diagnosis under most circumstances. Health care professionals, including emergency room doctors and nurses, should be trained to recognize the emergency nature of this condition and act promptly to give the patient proper medical care.

If you or a loved one has suffered from the cauda equina syndrome because of medical malpractice or the negligence of another, then contact the personal injury attorneys at Levine and Glassman, P.A. Our experienced attorneys welcome your call to discuss the particular facts of your case.

Causes of Cauda Equina Syndrome

Cauda equina syndrome can have any number of causes including:

• A postoperative hematoma;
• Spinal stenosis which is the narrowing or compression of the portion of the vertebral canal where the cauda equina is located;
• Rare complications of spinal surgery caused by the over-manipulation or aggressive manipulation of the delicate cauda equina nerves by the surgeon during decompression surgery;
• Ruptured disk;
• Lumbar disk herniation;
• Neoplasms or spinal tumor;
• Infectious conditions;
• Inflammatory conditions;
• Meningiomas
• Metastatic tumors
• Fracture;
• Ependymomas;
• Schwannomas; or
• Accidental medical causes or intervention (iatrongenic causes)
  
  • improper positioning of screws inserted in the spine that compress and damage nerves
  • a spinal tap or lumbar puncture can results in blood collecting in the spinal canal when the patient receives anticoagulation therapy to thin the blood which, if left untreated, can cause cauda equina syndrome by compressing the nerves.
• Trauma or violent impact such as a fall, car crash, penetrating injury such as a stabbing or gunshot;

Symptoms of Cauda Equina Syndrome

CES is a rapidly-evolving neurologic disorder related to spinal cord and spinal cord leash compression which often causes a very specific set of symptoms. Although symptoms can vary widely from individual to individual, common symptoms can include:

• dysfunction or loss of control over the bladder or bowel;
• bilateral sciatica;
• decrease in rectal sphincter tone;  
• analgesia or progressive loss of sensation in the legs, thighs, back of legs, hands or feet progressing to paralysis;
• saddle anesthesia (i.e., no sensation in the legs, anus or accompanying regions); and
• weakness or numbness in one or both legs that causes the individual to have sudden difficulty standing or walking.

Why is CES a Neurosurgical Emergency?

Cauda equina syndrome refers to a medical condition involving dysfunction of the cauda equina. The condition is described as a neurosurgical emergency because the longer the delay between neurologic injury and surgery the lower the chance of recovery. In fact, cauda equina syndrome has been described as the only true low back pain emergency.

These nerves at the base of the spine control the activity, function, and sensation of the penile, bladder, vulvar. When a nerve is compressed, the tiny blood vessels that are necessary for the life and oxygenation of the nerve are compressed.

Failure to relieve the compression results in death of the nerve. Compression of the nerve also compresses axoplasmic flow, which cuts off the conveyance of nutrients through the length of the nerve resulting in degeneration of the nerve.

When left untreated, the patient will often have irreversible problems because other nerves will be affected including the sacral nerves that go to the organs of the perineum and pelvis. In men the perineum or saddle area includes the testes, penis, and scrotum.

Cauda equina syndrome with severe bladder and bowel problems often require external or internal assistive devices such as a catheter.

Diagnosis of Cauda Equina Syndrome

Medical professionals often argue that cauda equina syndrome is difficult to diagnose. Often the patient walks into the doctor's office complaining of the loss of sensation in the legs or sudden problems with bladder or bowel function. Symptoms can vary from individual to individual and vary in intensity.

When the patient complains of these "hallmark" symptons, medical professionals should refer the patient to a neurologist. neurosurgeon or to order diagnostic tests including a

• lumbosacral spine x-ray;
• an MRI;
• a CT; or
• a myelogram which is an invasive procedure that involves injecting dye into the patient's spinal cord.

Received one of these tests can diagnosis the stenosis of his spinal canal or block of the spinal canal. In many of these cases a patient has significant narrowing of the spinal canal from a bulging disc or a herniated disc fragment.

Treatment of Cauda Equina Syndrome

Once a diagnosis is made, the doctor will often need to perform immediate emergency surgery to eliminate the compression of the nerves before the damage becomes permanent and irreversible. Left untreated permanent nerve damage will result. The victims of medical malpractice which contributes to cauda equina syndrome may have considerable damages and require ongoing services from a continence advisor, an occupational therapist, or a sexual therapist. 

Protect Your Rights After Cauda Equina Syndrome

The Ft. Lauderdale and Miami medical malpractice attorneys at Levine and Glassman, P.A., are experienced in representing individuals throughout Florida who have suffered serious nerve damage or spinal court injuries, including the rare condition known as Cauda Equina Syndrome. The impact of this condition is particularly tragic when medical malpractice leads to a misdiagnosis, the failure to order certain tests to diagnosis the condition, or the failure to quickly perform emergency surgery.

Contact our personal injury attorneys today to discuss the particular facts and circumstances of your case. We welcome your calls to our office.

Cauda Equina Syndrome Information Center

Cauda Equina Syndrome Prevention, Symptoms, Treatments and Causes - Article from Emedicinehealth.com on this rare spinal cord injury including information on treatment and prevention.

Spinal Cord Injuries - Cauda Equina Syndrome - Medical article from MedicineNet includes information on statistics and stories related to cauda equina syndrome.

Cauda Equina Syndrome Resource Center - Website created by the Cauda Equina Syndrome Support Group (CESSG) which was started in 1999 as a place for people with CES to meet and share information about this rare medical condition. 

Information on Cauda Equina Syndrome - Surgery and treatment information from the American Academy of Orthopaedic Surgeons.

Wiki Page on Cauda Equina - Wikipedia article from the free encyclopedia on cauda equina compression syndrome. 

Cauda Equina Syndrome Support Group (CESSG) - Website provides support, resources and information to those diagnosed with Cauda Equina Syndrome (CES).