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Last Updated: Saturday, 7 August, 2004, 23:20 GMT 00:20 UK
Delayed diagnosis paralysis risk
Woman with back pain
Acute back pain can be a sign of the condition
Doctors are being urged to be vigilant for the signs of a rare surgical condition which can lead to paralysis if undiagnosed.

Symptoms of cauda equina syndrome include acute lower back and leg pain and problems passing urine or faeces.

But a Journal of the Medical Defence Union article warns doctors often fail to spot the condition early enough.

David Markham, chairman of the MDU, says this leaves doctors at risk of being sued.

Cauda equina means 'horse's tail' in Latin
It refers to a network of nerve roots underneath the outer membrane which covers the spinal cord
Symptoms include acute lower back pain, numbness in the buttocks, pain in both legs, urinary retention and absolute constipation
Doctors may not diagnose the condition unless all symptoms are present

He highlights three cases where patients were left with long term health problems, though not paralysis, where this happened.

Financial settlements were made in all three cases.

Mr Markham said none of the doctors involved had a defence because they had failed to consider cauda equina syndrome as a diagnosis.

He said the MDU was aware of 95 cases where there had been problems with a diagnosis of the condition, 65% of which had progressed into medical negligence claims.

Nearly half of cauda equina syndrome cases resulted in compensation being paid to patients, compared to 34% of UK claims as a whole.

The highest amount paid to so far has been 759,000. But one case, yet to be settled, has been reserved at 1.1m.

'Difficult to refute'

Mr Markham, who is also a consultant orthopaedic surgeon, urged GPs, NHS Direct advisers, triage nurses and medical staff in accident and emergency to ensure they were aware of the as the condition most commonly occurs in the community.

He added: "Cauda equina syndrome is an acute surgical emergency which occurs when a group of nerves at the base of the spine become trapped.

"It is an uncommon condition, rarely encountered by most doctors but once suspected it is not a difficult syndrome to investigate.

"Early diagnosis and urgent action is essential as failure to treat promptly always leaves the patient with permanent, severe, devastating disabilities and the doctor facing potential allegations of negligence which may be difficult to refute."

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