Cauda equina syndrome (CES) is a rare but severe medical condition that requires prompt diagnosis and treatment to prevent irreversible damage and lifelong health problems. As such, medical professionals have a number of investigations available to them to help them diagnose patients presenting with symptoms. 

Prompt diagnosis of cauda equina syndrome is essential to ensure that patients receive the urgent treatment they require to minimise the long-term impact of the condition. In this guide, we will explore the various ways to diagnose this condition, emphasising the importance of early detection.

Why it is so important to accurately diagnose cauda equina syndrome

Cauda equina syndrome is a serious neurological condition that arises due to the compression of the cauda equina nerves, which are situated at the lower end of the spinal cord. These nerve roots play an integral role in motor and sensory function in the lower body, sending messages to and from the pelvic organs, as well as controlling bladder and bowel function.

If a person experiences certain health issues - such as a herniated disc, tumour, infection, fracture or narrowing of the spinal canal - this cluster of nerve roots can become compressed. This can lead to a host of distressing and disruptive symptoms, including:

• Severe lower back pain
• Numbness or pins and needles/tingling in the lower body
• Muscle weakness in the legs
• Changes to bladder or bowel function or loss of control 
• Sexual dysfunction and a loss of sensation

The importance of early diagnosis and treatment of cauda equina syndrome cannot be overstated. Without prompt intervention, cauda equina compression can cause permanent damage; moreover, the window for successful treatment is often quite narrow - generally within 24 to 48 hours from the onset of the red flags. If left untreated, cauda equina syndrome can result in long-term nerve damage and issues such as chronic pain, incontinence, loss of sexual function and paralysis in the legs. 

Lower back pain is a common issue in the general population and as such, there is often a danger that cauda equina syndrome will be misdiagnosed by doctors as sciatica, even when red flags such as altered urinary or bowel function are present. However, this is a significant problem, because delayed diagnosis will exacerbate the severity of the condition and the lead to the symptoms becoming permanent due to it being much more difficult to provide effective treatment.

This is why it is so important for medical professionals to be able to diagnose cauda equina syndrome. By using all of the diagnostic tools available, doctors and nurses can ensure that any red flag symptoms for cauda equina syndrome are caught as soon as possible.

MRI Scans: The Gold Standard for Cauda Equina Diagnosis

Magnetic resonance imaging (MRI) is essential to confirm a diagnosis of CES. This detailed scan provides high-resolution images of the spinal cord, which shows any abnormalities that are present, including compression of the cauda equina nerves.

If cauda equina syndrome is suspected, the MRI scan should be done on an urgent basis to avoid any unnecessary delay in treatment.

Tests Used to Aid Cauda Equina Diagnosis

While MRI scans play a crucial role, several physical tests can aid in diagnosing CES. These tests, performed during a physical examination, can provide valuable information about a patient's neurological function.

Straight Leg Raise Test

The Straight Leg Raise (SLR) test is a physical examination used to determine if a patient with lower back pain has an underlying herniated disk, often a cause of cauda equina syndrome. During an SLR test, the patient lies down, and the doctor slowly raises the patient's leg, keeping the knee straight.

Pain that radiates down your leg while your knee is extended indicates possible pressure on the nerve roots, which is a potential indicator of cauda equina syndrome.

Pinprick Test

The pinprick test is used to assess sensory function in the lower body. The doctor uses a pin to gently prick different areas on the skin. If the patient cannot feel the pinprick, or if the sensation is diminished, this could be a sign of cauda equina syndrome.

Bulbocavernosus Reflex Test

The bulbocavernosus reflex (BCR) test checks for the presence of a specific reflex that involves the muscles of the buttocks and those that control the exit of the bladder. An absent or abnormal reflex can be an indication that the cauda equina nerve roots are being compressed.

Catheter Tug Test

In patients with urinary retention due to suspected cauda equina syndrome, a catheter tug test can be performed. A quick pull on the catheter causes a normal reflex contraction of the external urethral sphincter. If this reflex is absent, doctors will recognise this as a potential sign of cauda equina syndrome.

Digital Rectal Examination

This is another important test for suspected cauda equina syndrome. During one of these examinations, the doctor checks for tone and sensation in the rectal muscles, as decreased tone or loss of sensation can be indicators of issues with the spinal cord.

Ankle Reflex Test

The ankle reflex test assesses the integrity of a specific nerve root in the lumbar spine. Diminished or absent reflexes in the ankle may be indicative of compression of the nerve roots caused by cauda equina syndrome.

What Happens When Cauda Equina is Diagnosed?

When cauda equina syndrome is confirmed, this is considered to be a medical emergency. Immediate surgical intervention is required to decompress the affected nerves and prevent further damage; the sooner this surgery is performed, the better the outcome for the patient. Post-surgery, patients may require physical rehabilitation, pain management and potentially long-term care, depending on the severity of the condition.

This is why it is so important that these tests are carried out promptly and correctly. If a patient is showing red flag symptoms of cauda equina syndrome and they are not checked correctly, they will not receive the treatment they need - potentially leading to lifelong sensory and motor deficits, chronic severe pain, and issues with bladder and bowel dysfunction.

If you have developed cauda equina syndrome and believe that your doctors failed to properly assess your symptoms at the right time, causing the diagnosis to be delayed or missed, you may be able to make a medical negligence claim - especially if it can be shown that these delays have led to further health complications or permanent damage.

At JMW Solicitors, we have a wealth of experience dealing with cauda equina syndrome negligence claims and can provide expert guidance and support. To learn more, contact us on 0345 872 6666,or complete our online contact form and we will get in touch with you about making a cauda equina syndrome claim.