Alleged delays in treating suspected cauda equina syndrome

 

Summary

Mrs Griffiths alleged that delays in treating suspected cauda equina syndrome in 2017 caused lasting neurological injury. The claim failed on both breach of duty and causation.

Learning points

General

• Identify the factual assumptions underpinning each opinion. Explain how the opinion changes if the court accepts a different history.

• Address contrary contemporary evidence directly, including patients’ letters and questionnaires, rather than relying predominantly on later recollection.

• Separate breach, the likely alternative course of treatment, and medical causation. Each requires its own analysis.

• Distinguish proof of present abnormality from proof of its timing and cause. An unexplained alternative does not establish the proposed cause.

• Make concessions and their consequences clear. Here, concessions materially narrowed the apparent disagreements.

For rediologists

• Explain the imaging features underlying descriptive terms such as “moderate” or “severe”, particularly where grading is not standardised.

• Distinguish spinal canal stenosis and other nerve-root compression from demonstrated cauda equina compression.

• Explain whether a reporting difference would actually have changed management, considering all imaging available at the relevant time.

For orthopaedic experts

• Analyse onset, duration and progression separately; identifying red flags alone does not resolve the disputed urgency.

• Assess the history and findings available to the treating team at the time.

• Explain precisely why emergency rather than urgent referral was required, and acknowledge histories under which either approach would be reasonable.

For neurosurgeons

• Distinguish an indication for surgery from an indication for emergency surgery.

• Integrate clinical history and imaging; explain how any proposed mechanism of injury fits both.

• When using later guidance, establish its relevance to practice at the material time and recognise that pathways do not replace individual assessment.

• Address postoperative recovery explicitly when explaining causation, including how later objective abnormalities fit the intervening clinical course.

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