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Cauda equina syndrome: a review of the current clinical and medico-legal position

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Abstract

Cauda equina syndrome (CES) is a rare condition with a disproportionately high medico-legal profile. It occurs most frequently following a large central lumbar disc herniation, prolapse or sequestration. Review of the literature indicates that around 50–70% of patients have urinary retention (CES-R) on presentation with 30–50% having an incomplete syndrome (CES-I). The latter group, especially if the history is less than a few days, usually requires emergency MRI to confirm the diagnosis followed by prompt decompression by a suitably experienced surgeon. Every effort should be made to avoid CES-I with its more favourable prognosis becoming CES-R while under medical supervision either before or after admission to hospital. The degree of urgency of early surgery in CES-R is still not in clear focus but it cannot be doubted that earliest decompression removes the mechanical and perhaps chemical factors which are the causes of progressive neurological damage. A full explanation and consent procedure prior to surgery is essential in order to reduce the likelihood of misunderstanding and litigation in the event of a persistent neurological deficit.

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Acknowledgments

The authors are grateful for comments and encouragement from Mr Andrew Ransford FRCS and Dr Bjorn Rydevik.

Conflict of interest

No conflicts of interest are declared.

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Authors and Affiliations

  1. South Essex University Hospitals and The Essex Spine Centre, Brentwood, UK

    Alan Gardner

  2. Southampton General Hospital, Wessex Orthopaedic Rotation, Southampton, UK

    Edward Gardner

  3. Royal National Orthopaedic Hospital, Stanmore, UK

    Tim Morley

  4. 1 Hyde Lane, Danbury, Essex, CM3 4QX, UK

    Alan Gardner

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  1. Alan Gardner
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  2. Edward Gardner
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Correspondence to Alan Gardner.

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Gardner, A., Gardner, E. & Morley, T. Cauda equina syndrome: a review of the current clinical and medico-legal position. Eur Spine J 20, 690–697 (2011). https://doi.org/10.1007/s00586-010-1668-3

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  • DOI: https://doi.org/10.1007/s00586-010-1668-3

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