The feeling of pain in general can be very distressing for a lot of people. Back pain is very common among people between the ages of 35 and 55 years. Individuals who suffer with back pain sometimes report feeling of numbness and weakness to the leg. However, having a combination of these does not always mean that you require emergency medical attention.
You have been referred to our same day emergency surgical access service through the Surgical Assessment Unit (SAU) as you have reported experiencing a combination of symptoms that require that we rule out a rare but serious condition called Cauda Equina Syndrome (CES). It is a condition where the nerves at the bottom of the spinal cord become compressed and can cause permanent damage.
This leaflet is designed to help you understand what to expect whilst attending our service and next steps following a diagnosis.
Frequently asked questions
Who will I be seeing?
You may have been previously seen by a specialist in our emergency department who thinks you require further assessment, and a special scan called Magnetic Resonance Imaging (MRI) to rule out suspected CES. At this appointment, you will be seen by a team of Orthopaedic surgeons and Nurses.
Why do I need an MRI scan?
Although your symptoms have been triaged and you have had a clinical assessment and other physical examinations, these are not enough to give good diagnostic accuracy. Therefore, combining all of these with an MRI scan will give us a clearer picture and enable us to make the best clinical judgement and in turn initiate the best treatment plan for you.
When will I have my scan?
We endeavour to scan you as soon as possible however; due to other emergencies this may not always be a possibility. We would normally communicate a scan time with you within a set timeframe on the same day you attend the SAU, this is usually within 4 hours of us requesting a scan. Once you have had your scan, you will need to return to the SAU where you will have to wait for your scan results to be reported and discussed with you.
When will I receive my scan results?
Once your scan is reported, in line with national guidance, we immediately transmit this information to our neurosurgical colleagues at University Hospitals Coventry & Warwickshire (UHCW) for further investigation and input to ensure that we cover all areas. Unfortunately, there may be delay in receiving reports from this team in certain circumstances (for example when they are in surgery), this implies that there may be a longer than anticipated wait time to receive your results.
Can I eat and drink while awaiting my results?
This will depend on your previous clinical assessment with your doctor, not all individuals are allowed food or drink. Please speak to the nurses to find out if you are allowed food or drink whilst awaiting results.
I have been waiting for so long when will a decision be made?
We do not anticipate that you would be waiting longer than 6 hours, if in the unfortunate circumstance this happens, you will be reviewed by a senior member of the orthopaedic team at about 5.30pm who would decide whether you can return another day or be admitted in the hospital overnight for observation.
My results have now come back and reported as normal, but I still have pain?
If your scan is reported as normal and no cause for your symptoms is found, this may be due to other musculoskeletal causes and would be expected to improve with time. You would be discharged with adequate pain control medication to manage your pain. Please contact your GP to consider referring you to other speciality services for pain management.
My scan report found a cause for my pain, but it is not CES what do I do?
It is reassuring to know that your pain is not due to CES, therefore, your symptoms are very likely to improve. This may occur with a combination of therapies including referral to other specialist services like physiotherapy or pain control team. You will be informed of how this will be initiated prior to discharge. You will also be supplied adequate pain control medication for symptomatic relief. It is important to note the following progression of symptoms of CES, should you experience a combination of the following, please visit your nearest emergency department immediately
- Loss of feeling/pins and needles between your inner thighs or genitals
- Numbness in or around your back passage or buttocks
- Altered feeling when using toilet paper to wipe yourself
- Increasing difficulty when you try to urinate
- Increasing difficulty when you try to stop or control your flow of urine
- Loss of sensation when you pass urine
- Leaking urine or recent need to use pads
- Not knowing when your bladder is either full or empty
- Inability to stop a bowel movement or leaking
- Loss of sensation when you pass a bowel motion
- Change in ability to achieve an erection or ejaculate
- Loss of sensation in genitals during sexual intercourse
My result has come back positive for CES what happens next?
As a priority, we will immediately transfer your care to our spinal surgery colleagues at UHCW in Coventry for definitive management. It is important that you remain nil by mouth as assessment for surgery may be required within the next few hours. This will involve transfer to UHCW for continued care, alternatively an urgent outpatient referral may be requested, and you will be contacted in due course by the neurosurgery team.
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