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Timely detection and treatment of cauda equina syndrome


The national investigation

We identified a patient safety risk involving the timely detection and treatment of non-malignant spinal cord compression (cauda equina syndrome).

The Cauda Equina is a group of nerves located below the spinal cord. Cauda equina syndrome (CES) is a rare and severe type of spinal stenosis (a condition where the space around the spinal cord narrows, compressing a section of nerve tissue). CES causes all the nerves in the lower back to become suddenly and severely compressed. It can be caused by disc protrusion, tumour or trauma. It disrupts motor and sensory function to the lower extremities and bladder.

If CES is not diagnosed and treated in a timely way it can lead to permanent incontinence, sexual dysfunction and even paralysis.

Reference event

The investigation was launched after HSIB identified an event where a patient had several GP and hospital presentations before CES was diagnosed. Once an MRI scan identified the cord compression, there were further barriers to receiving timely emergency surgery to alleviate the compression.

Investigation summary

This investigation focused on:

  • assessing the resilience, consistency and reliability of the pathway(s) for patients experiencing potential red flags for CES
  • seeking to understand the context and contributory factors influencing the pathway for patients with CES from their first presentation
  • reviewing the national context surrounding the timely detection and treatment of spinal nerve compression (CES) in patients with back pain.