CES & Spinal Cord Compression: 8 Things Solicitors Should Know Before Instructing An Expert

But elapsed time alone rarely tells the whole story.

In these claims, the more important issue is often how the claimant’s neurological presentation changed over time. A patient may progress through different stages of cauda equina syndrome, and they may still be able to pass urine despite having incomplete CES. The critical chronology is therefore neurological, not simply a calculation of hours between presentation, imaging and surgery.

For solicitors, this means separating breach from causation and identifying the point at which symptoms should reasonably have triggered investigation, referral or treatment. It also means asking whether acting at that point would probably have prevented some or all of the subsequent neurological deterioration.

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Drawing on 13 years of medico-legal experience, Consultant Neurosurgeon and Spinal Surgeon Mr Nikolaos Tzerakis shares the issues solicitors should identify early when assessing breach, causation and neurological outcome in complex spinal claims. He has been a Consultant Neurosurgeon since 2012 and undertakes 24 to 36 medico-legal reports each year across clinical negligence and personal injury matters.

Based on his recent INNEG webinar, Cauda Equina & Cord Compression, this guide focuses on the practical clinical and evidential issues that can become decisive when investigating these claims.

Inside you’ll learn:

• Why the chronology should be built around neurological deterioration rather than elapsed time alone.
• Why the relevant question may be when CES should first have been suspected, not when it was eventually diagnosed.
• Why a normal lumbar MRI does not necessarily resolve the issue where significant neurological symptoms remain unexplained.
• How to test whether statements such as “normal neurology” are actually supported by the underlying clinical examination and records.
• Why referral, imaging, reporting, handover, transfer and the actioning of results should be assessed as one complete pathway.
• How several relatively small delays can become significant when considered cumulatively.
• Why the expert should be asked to address the claimant’s likely neurological outcome in the counterfactual scenario.
• Why relying on a fixed 48- or 72-hour window can oversimplify causation.
• How to identify whether there was an earlier actionable opportunity that could genuinely have changed the outcome.

The guide also highlights an important issue that can easily be missed when reviewing imaging. A normal lumbar scan may not explain persistent neurological symptoms if the underlying pathology is located higher in the spine, meaning solicitors should establish what was actually scanned, what symptoms remained unexplained and whether further imaging should have followed.

Similarly, a serious eventual outcome does not prove that an earlier breach occurred. The records still need to establish what symptoms or pathology were present at the point negligence is alleged, what should reasonably have prompted different management and whether earlier intervention would probably have altered the neurological outcome.

Whether you are assessing an initial enquiry, reconstructing the chronology, considering breach or preparing instructions for a spinal expert, this guide will help you focus on the missed opportunities that actually matter.

Before instructing, solicitors should be able to identify when the claimant’s neurological presentation materially changed, when further investigation or treatment should have occurred, where time was potentially lost and whether intervention at that point would probably have changed the outcome.