In a recent article in the British Journal of Neurosurgery a group of clinicians based in Hull Royal Infirmary set out to encourage the NHS to implement a national policy of 24/7 MRI scanning availability for cases of suspected cauda equina syndrome and to agree on a national, evidence-based referral pathway.

Patients who present with suspected cauda equina syndrome require clinical imaging, which is most commonly in the form of an MRI scan, in order to confirm a diagnosis of cauda equina syndrome. In a significant proportion of patients who present with potential "red flag" signs or symptoms which include bladder dysfunction, saddle numbness and bowel dysfunction - a diagnosis of Cauda Equina Syndrome will be excluded once an MRI scan has taken place.

Recognising the improved outcome for patients who have earlier surgery, the authors of the recent paper analyse the referral pathways of 250 patients with suspected cauda equina syndrome - i.e. those who have some potential red flag features - who were referred to the regional neurosurgical unit. Of those patients, 73% presented out of hours (during evenings or at weekends) without prior scanning and of those 82% had to wait until the next day for investigations.

The authors conclude, in accordance with previous studies, that red flag signs and symptoms are insufficient to diagnose cauda equina syndrome alone without the benefit of scanning. There is often a limited window from the onset of cauda equina syndrome symptoms to successfully operate and prevent permanent nerve damage from being caused. Clearly if diagnosis is delayed due to MRI scans not being arranged then the chance of a patient making a full recovery will be severely hampered, devastating lives. For such a relatively rare condition, cauda equina syndrome is disproportionately represented in clinical negligence cases. I and the other spinal injury solicitors at JMW are representing a large number of patients with permanent cauda equina syndrome that was directly caused by a failure to carry out an urgent MRI scan and perform emergency surgery. Given this, it is important that these recommendations for round-the-clock MRI scans and national referral pathway are given consideration at national policy level.