We have 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 will consider:

  • The context and contributory factors influencing the pathway for patients with non-malignant cord compression (cauda equina syndrome) from first presentation. This potentially spans different care settings.
  • The barriers for timely diagnosis.
  • What influences clinicians’ decision making when deciding whether to refer patients for an MRI scan to diagnose CES.
  • Whether patients presenting to their GP with lower back and radicular pain have access to an appropriate specialist able to respond in a timely fashion.

Safety recommendations

As part of our final investigation report we’ll make safety recommendations to the appropriate national bodies in order to improve patient safety.

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