Abstract
To establish the incidence of litigation in Cauda Equina Syndrome (CES) and the causes of litigation.
Review of 10 years of abbreviated records of the National Health Service litigation authority (NHSLA) (1997-2007) and eight years of medical negligence cases (MNC) reported on by the two senior authors (2000-2008).
Patients who experienced CES and litigated. There were 117 patients in the NHSLA records and 23 patients in the MNC group.
Review of timing of onset, delay in diagnosis, responsible specialist, place, and resulting symptoms
NHSLA cases. 62/117 cases were closed. The responsible specialists were as follows
| Orthopaedic | 60 |
| Accident and Emergency | 32 |
| Other | 25 |
The commonest failure was delay in diagnosis, and the commonest complications were “neurological”, bladder and bowel.
MNC cases. F:M;17/6. L4/5 13 cases, L5/S1 9 cases. The responsible specialist was orthopaedic (7), other (7) and in 8 cases the opinion was that there was no case to answer. Delay to treatment averaged 6.14 days. 18/23 patients described bowel and bladder symptoms, the information was not available in the remainder.
Litigation is major problem in CES. In most cases orthopaedic surgeons are litigated against, and bowel and bladder symptoms remain the most disturbing cause of litigation. These surgeons are mostly not spinal specialists. In most successful cases of litigation there is considerable delay in diagnosis and management. Where there is incomplete Cauda Equina Syndrome urgent or emergency investigation and treatment is mandatory.
