Cauda equina syndrome (CES) is a severe neurological disorder that appears to have been first described by Mixter and Barr in 1934. The disorder can be caused by any entity exerting pressure upon the cauda equina including hematomas, tumours, infections or fractures. More importantly, however, between two and six percent of lumbar disk herniations result in cauda equina syndrome. As a consequence, if a patient suffers from cauda equina syndrome, the cauda equina compression is most likely secondary to a disk herniation. Most authors define cauda equina syndrome as a neurological disorder characterised by clinical features of low back pain, bilateral or unilateral leg pain (radiculopathy) saddle anesthesia (reduced sensation in the perineum, buttocks, anus, groin, and upper thighs), motor weakness, sensory deficit, and bladder or bowel incontinence. Although patients with cauda equina syndrome may present to their family practitioners or even specialists such as neurosurgeons or orthopedists, a far greater number present to the emergency 72 LAWYERMONTHLY FEBRUARY 2023 Medical Malpractice and Cauda Equina Syndrome ExpertWitness Cauda equina syndrome is a disorder with extreme consequences for its victims especially if a healthcare provider fails to diagnose or timely treat this emergency disorder. This month, Lawyer Monthly hears from Dr. Charles E Rawlings, a neurosurgeon and expert witness as well as a nationally recognised plaintiff’s medical malpractice attorney. He has written extensively on the condition and treated many patients with cauda equina syndrome. Here, he explores why it is important to diagnose and treat cauda equina syndrome early – and the numerous ways in which failure to do so may constitute medical negligence.
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