Failure To Do MRI Delays CES Diagnosis

From November 2013 Mr B attended weekly sessions with an osteopath but the pain in the back and lower legs worsened.  On 10 December 2013 B attended his GP complaining of sciatica in both legs. The GP prescribed further painkillers and requested an MRI scan.  
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By the evening of 23 December 2013 B’s symptoms had deteriorated.  He noticed difficulty passing urine and getting an erection. He also noted reduced sensation around his anus.  

On the morning of 24 December 2013, Mr B noticed the pain had progressed and he was suffering from shooting pains down his legs into his calves with pins and needles. His assessment included an anal tone test.  He noticed reduced sensation around Mr B’s anus and groin and difficulty urinating. Mr B attended his GP. The GP carried out an examination and recorded reduced anal tone, saddle anaesthesia and difficulty urinating. 

The GP telephoned the hospital to arrange an orthopaedic assessment and an MRI scan that day, to rule out Cauda Equina Syndrome.  

Mr B attended hospital on 24 December 2013 and was seen by a junior doctor. Mr B advised the doctor of his symptoms. The junior doctor discussed the case with her registrar (who significantly did not examine Mr B) and she then performed an anal tone test. Having determined Mr B had normal anal tone, an MRI scan was not arranged.  Mr B was told he was suffering from back pain and was sent home.  

Mr B remained in severe pain over the Christmas period.  He continued to suffer with numbness and by the new year he had experienced episodes or urinary incontinence.  

On Friday 3 January 2014 Mr B finally underwent the MRI scan which his GP had requested on 10 December 2013. 

 On 6 January 2014, Mr B was contacted by his GP advising that the MRI report showed an L4/5 central disc protrusion. Mr B was urgently assessed in hospital and diagnosed with Cauda Equina Syndrome.  Spinal decompression surgery was performed on 7 January 2014.