Cauda Equina Syndrome – a life changing spinal injury

Miss D developed some low back pain which was travelling into her legs in September 2011.  Her GP rightly referred her to Physiotherapy via the local hospital Trust and when her symptoms worsened he made a second referral in October 2011 to the Orthopaedic Spinal Service.  Miss D was seen by a Nurse Practitioner in Orthopaedics and complained of some unusual symptoms in that she could not feel when her bladder was full.  The Nurse Practitioner did not pick up on this but arranged for Miss D to have an MRI scan but this was not to take place for a further 6–7 weeks.

Miss D continued to attend her Physiotherapy sessions.  In November, when she noticed that she was struggling to pass urine and that she had some numbness around her buttocks and genitals, she reported this to her Physiotherapist who sent her urgently to A&E.  Miss D was admitted to hospital with an plan to have an urgent MRI but instead she was discharged home the following day with advice to wait for the already booked scan which was still some 3–4 weeks away.

Miss D eventually had the MRI scan of her spine as planned in the week before Christmas in 2011.  A couple of days later she then received a telephone call from the hospital asking her to come into hospital that evening to undergo urgent surgery.  The scan had shown a disc at the very bottom on her spine was protruding and pressing on the nerves there.  She was suffering from Cauda Equina Syndrome.

Miss D underwent a L5/S1 decompression operation that night.  This halted further damage being caused but could not undo the damage which had already been done to the nerves affecting her urinary, bowel and sexual function.

She was therefore left unable to open her bowels normally or void her bladder without using a catheter up to 7 times a day.  She was left with no sensation in the saddle area, agonizing neuropathic pain, cramping in her toes, depression and fatigue.  Further, as a result of all of these conditions, the low back pain she had previously suffered increased in severity and frequency.

Prior to her developing low back pain, Miss D had been a Carer for her long term partner and their adult son who both suffered with long term health complications, both mental and physical.  Following her surgery, Miss D was unable to offer either of them the same level of care she had previously provided as she now required help and assistance.

Miss D consulted us in 2013.  We investigated the treatment she had received.  An independent Orthopaedic Surgeon was of the view that Miss D condition should have been suspected and diagnosed in November but also raised concerns about the Nurse Practitioner’s failure to arrange an urgent MRI scan when Miss D complained of urinary symptoms in October.  With a diagnosis and treatment at this time, Miss D would have avoided any bowel and bladder dysfunction and would have made a full recovery.

The Hospital Trust admitted breach of duty for failing to make an earlier diagnosis and accepted that they had caused some of the injuries which Miss D complained about but they did not accept that her current level of back pain could be attributable to their mistakes.  As a result, we started court proceedings.

We continued to investigate the cause and extent of Miss D’s injuries with a Neurosurgeon, a Urological Surgeon, a Bowel Surgeon and a Psychiatrist.  We obtained reports on what level of care and assistance Miss D now needed and what other therapies and aids and equipment she needed now and for the rest of her life as a result of the admitted negligence.

The claim continued for Miss D.  We arranged for her to undergo Cognitive Behavioural Therapy and Eye Movement Desensitization and Reprocessing (EMDR).  Miss D was reluctant at first but the medication prescribed by her GP was not helping and she felt so low that she agreed to engage with a therapist.  We obtained some interim payments of compensation for her so she could buy some of the aids she needed, change her car to one with a more comfortable driving position and replace items in the home that she needed as a result of her condition.

The Defendants maintained that her current level of back pain was not a result of the negligence and they also insisted that the Claimant be examined by independent experts that they instructed.  With both parties having very opposing views on the cause of the current level of back pain and therefore the amount of compensation due to Miss D, the last step before trial was to have the experts instructed by both sides to meet and discuss their differences and provide a joint report on the issues on which they agreed and disagreed.

It was only at this stage, only 4 months before trial, that it was agreed by the Defendant’s Orthopaedic expert that while the negligence had not worsened Miss D’s underlying degenerative back condition, the fatigue, depression, anxiety and neuropathic pain which were all a result of the admitted negligence HAD in fact had the effect of worsening her back pain as claimed.  With four weeks left before a 7-day trial, the parties met and agreed a settlement of almost half a million pounds.

On the face of it, this was a straightforward case but the parties had such polar opposite views on the cause of the worsening back pain that the matter could not be resolved until the experts with the opposing views met.  We had asked the Solicitors to agree to this some 6 months earlier but this was refused.  This was a difficult case for the Claimant and at times she felt she should give up but we supported her and with her family and therapist helped build her up when she felt she couldn’t continue.

By the end of the case, she was able to see that her decision to come to us to investigate this claim had been the right one.  While we could not repair the damage done, we had helped her achieve the means to make her life easier and more comfortable.

A claim for medical negligence can be lengthy and challenging and once you suspect you have suffered an injury as a result of unacceptable treatment, the most important choice you then have to make is instructing the right Specialist Solicitor who will guide and support you through the claim.  We are always happy to discuss any potential claims.  This is all we do and all we know.  Don’t hesitate to contact us.

Ashleigh Holt – February 2020