Cauda Equina: Damages to the patient and to the NHS bank balance

Back pain is an extremely common ailment presented in primary care and while the vast majority of patients are experiencing muscular or disc related conditions, a minority could be experiencing symptoms of Cauda Equina Syndrome (CES). CES is a potentially life-threatening condition that can present initially with symptoms similar to common back pain problems, such as lower back pain, sciatica on both sides and weakness in both legs.

The cauda equina, Latin for horse’s tail, is a bundle of spinal nerves and spinal nerve rootlets, consisting of the second through fifth lumbar nerve pairs, the first through fifth sacral nerve pairs and the coccygeal nerve. These nerves arise from the lumbar enlargement and the conus medullaris of the spinal cord.

An injury to the cauda equina, if not treated in a timely manner, can have devastating effects on the patient and their chances of positive long-term recovery.

The results of some high profile CES cases have recently hit the headlines with the BBC’S report concluding that after 24 hours, the damage to the cauda equina is such that outcomes for patients become significantly worse.

The only way to definitively diagnose CES is with an MRI and the intervention of an experienced specialist spine surgeon. With neither service available in hospitals on a 24-hour basis, this becomes a contributing factor to delay in diagnosis and treatment.

Once a CES diagnosis has been given, immediate surgical intervention is required. According to the GIRFT Spinal Services Report, published in March 2019 “Nothing is to be gained by delaying surgery and should be undertaken at the earliest opportunity”.

Often the referral process itself can take days, if not weeks, and the consequences of delayed treatment are life-threatening at worst. Left untreated, most previously fit and healthy patients can be left incontinent, with a major disturbance of sexual function along with chronic back and leg pain.

Delays in “judgement and timing” and “lack of clinical picture/interpreting the data available to make a diagnosis” are the main reasons given for legal action against the NHS, and are accountable for 75% of all litigation made against the NHS spine services – one of the largest causes of litigation to the NHS.

The same report analysed data from 40 Specialised Providers of Complex Spinal Surgery, and reported that 4,441 CES referrals were made across a 6-month period alone; from 1st October 2016 to 31st March 2017. That’s a lot of potential litigation that surgeons and hospitals need to ensure they are protected against.

ReferBack™, by Amplitude, has been designed in conjunction with leading surgeons in BASS (British Association of Spine Surgeons), to streamline, structure and standardise the referral process. Delivering time-saving and administrative benefits to clinicians as well as acting as a learning tool for referring centres. The net result is improvements to the quality of healthcare delivered and increased patient safety, whilst providing an audit trail that will prove the quality of care delivered, record decision making and assist NHS Resolution and individual spine surgeons with future defence against negligence claims.

For more information on ReferBack™, call us on 0333 014 6363 or book a free demonstration.

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