title: Causes and outcomes of cauda equina syndrome in medico-legal practice: a single neurosurgical experience of 40 consecutive cases.
abstract: BACKGROUND
  This is a unique report of 40 patients litigating in relation to the management of a cauda equina syndrome (CES), with prospective data collection.
  
  
  METHODS
  Patients were seen and examined; medical records and radiological imaging were reviewed. The following data were collected prospectively: age; sex; the level of cauda equina (CE) compression; the pathology causing the compression; the clinical picture at first presentation; the causes of any iatrogenic injury; possible breaches of duty of care and the responsible discipline; recovery of bladder control; return to work.
  
  
  RESULTS
  There were possible breaches of duty of care for 39 patients initially, and for 69 patients overall. Twenty-eight patients presented with compressive degenerative pathologies (mainly central disc prolapses); all 28 had deteriorated to the point of bladder paralysis (complete CES (CESR)) at the time of treatment. Twenty-six (93%) had voluntary bladder control at presentation. Long-term bladder paralysis was probably avoidable in over 90% of patients. Eleven patients had iatrogenic injuries: all had long-term bladder paralysis. Thirty-four patients had bladder paralysis (CESR) at the point of decompressive surgery. Recovery of bladder function occurred in only seven patients (21%), i.e. long-term bladder outcomes were poor. Only 22% of patients returned to work.
  
  
  CONCLUSIONS
  In this highly selected group of patients whose CES was not managed in an appropriate/standard fashion, 93% of patients had long-term bladder, bowel and sexual dysfunction that was probably avoidable. Mismanagement of patients with iatrogenic injuries was associated with a universally poor outcome.
authors.affiliation: Regional Neurosciences Centre, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK.
authors.forename: Nick V
authors.initials: NV
authors.lastname: Todd
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000331:legislation & jurisprudence / Q000592:standards; D003695:Delivery of Health Care / Q000331:legislation & jurisprudence / Q000592:standards; D004651:Employment; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D019300:Medical Errors / Q000331:legislation & jurisprudence; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000331:legislation & jurisprudence* / Q000592:standards; D010243:Paralysis / Q000209:etiology; D011128:Polyradiculopathy / Q000209:etiology* / Q000601:surgery; D011446:Prospective Studies; D020127:Recovery of Function; D013130:Spinal Stenosis / Q000601:surgery; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000209:etiology; D055815:Young Adult