Surgeon, nurses miss signs of cauda equina syndrome

A man in his 20s went to see an orthopedic surgeon after having back pain that wouldn’t go away. Let’s call him Joe.

The surgeon ordered CT and MRI scans of his lower back, or lumbar spine. The scans showed that Joe had a herniated disc at the level of L3–L4 and spinal stenosis.

• The spinal vertebrae are separated by flexible cushions called discs. When a disc slips out of place it’s described as a herniated disc and can cause pain and other symptoms by compressing or pinching a nerve.

Spinal stenosis is a condition where the spinal canal is tighter than usual. This, too, can cause pain and other neurologic symptoms by compressing the spinal cord or nerves.

After trial of physical therapy, which didn’t work, Joe was left with a singular option: back surgery. He decided to go forward because the pain wasn’t going away and a pins and needles sensation went down his leg.

After the surgery, Joe noticed some new problems. It was painful walk and his left leg had a burning sensation. It was so bad that he described it as a 10/10 pain. He also couldn’t urinate.

Cauda equina syndrome

At the bottom of the spinal cord, typically at starting around L2 and extending toward the tailbone, the nerves collect into a structure that looks like a horse’s tail. In fact, that’s what the phrase cauda equina means in Latin.

Cauda equina syndrome occurs when there’s compression of multiple lumbar and sacral nerves. This condition can cause a number of classic signs and symptoms, including:

• Urinary retention. This is the most common symptom of cauda equina syndrome. Here, the patient’s bladder is full of urine, but there’s not an urge or ability to empty it by urination. Ultimately, in Joe’s case, a nurse emptied his bladder with a catheter. That’s a classic sign of urinary retention.

• Saddle anesthesia. This is a numbness of the saddle area of a person’s bottom, including the anus, genital area, and buttocks. Joe developed saddle anesthesia.

• Sciatic-type pain in the back and/or legs. Joe also had these symptoms.

• Sexual dysfunction, such as erectile dysfunction.

Diagnosis and treatment

We believe that in Joe’s case, his nurses and physicians should have suspected cauda equina syndrome. That should have led to a thorough physical exam and diagnostic radiology tests. Once the diagnosis is confirmed, experts describe the standard of care as emergency surgery to decompress the affected nerve roots.

When there is a delay in diagnosing and treating cauda equina syndrome, patients can be left with permanent dysfunction. Unfortunately, Joe’s surgeon and the nurses taking care of him failed to act on his numerous symptoms that pointed to cauda equina syndrome. That’s why he continues to experience pain, has to wear adult diapers because he can’t control his bowel or bladder function, has saddle anesthesia, and sexual dysfunction.

If you’ve been seriously injured because of a delayed diagnosis and treatment of cauda equina syndrome in Texas, contact a top-rated, experienced Texas medical malpractice lawyer for a free consultation regarding your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.