title: Cauda equina syndrome: a review of the current clinical and medico-legal position.
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.
authors.affiliation: South Essex University Hospitals and The Essex Spine Centre, Brentwood, UK. adhg@btopenworld.com
authors.forename: Alan
authors.initials: A
authors.lastname: Gardner
authors.forename: Edward
authors.initials: E
authors.lastname: Gardner
authors.forename: Tim
authors.initials: T
authors.lastname: Morley
mesh_terms: D019299:Decompression, Surgical / Q000331:legislation & jurisprudence / Q000379:methods / Q000592:standards*; D042241:Early Diagnosis; D004632:Emergency Medical Services / Q000331:legislation & jurisprudence / Q000379:methods / Q000592:standards*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008318:Malpractice / Q000331:legislation & jurisprudence / Q000639:trends*; D009460:Neurologic Examination / Q000379:methods / Q000592:standards; D011128:Polyradiculopathy / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D006113:United Kingdom