Mr H had initially contacted Blake Lapthorn, who has considerable experience in bringing cases of cauda equina syndrome, in March 2008.  The case was complex both in terms of liability and quantum.

Mr H, who is a roofer and builder by trade, had suffered intermittent back pain and sciatica since the age of 15.  In 2004 due to continuing back pain and numbness over the two outer toes of his left foot he attended a physiotherapist who referred him to a consultant orthopaedic surgeon at the Queen Elizabeth hospital in Kings Lynn.  An MRI scan revealed a prolapsed disc, which had completely obliterated the spinal canal.  A microdiscectomy was performed in June 2005, but was unsuccessful in improving Mr H's symptoms.  Mr H then began to suffer from pins and needles, had reduced sensation in his penis and he experienced difficulty in urinating with slow stream.  Physiotherapy produced no improvement and a further MRI scan showed a recurrence of the disc prolapse.  He was listed for a repeat discectomy, which the orthopaedic surgeon performed on 4 January 2007.

In the days following this operation, whilst Mr H's mobility and sciatic pain had greatly improved, it was clear that he had suffered a significant deterioration in his bladder and bowel function.  He required catheterisation, parasthesia over the perineum, was unable to open his bowels and required an enema.  A further MRI scan revealed a compromise of the cauda equina however no action was taken by the orthopaedic staff at the hospital to address the cause of these new symptoms and Mr H was discharged.

Mr H's symptoms worsened and his GP referred him for further treatment.  Another MRI scan showed further disc problems and his surgeon recommended further decompressive surgery but due to concern over failure of the previous surgery Mr H sought a second opinion.  This further opinion advised against additional surgery as there was no prospect of the residual cauda equina dysfunction being reversed and a significant risk of it being worsened.  Mr H accepted this advice and having made a formal complaint, sought legal advice.


Mr H tried a number of treatments to improve his bladder and bowel symptoms.  He had a sacral nerve stimulator and subsequently a pudendal nerve stimulator fitted to try and deal with his incontinence. This proved moderately successful in the short term, but then ceased to be effective.  Mr H continues to self-catheterise with the attendant problems with UTI, and has been placed on the waiting list for a clam cystoplasty, a major surgical procedure.  Mr H alleged that as a consequence of the failure to recognise and treat his post-operative complications, he has been left with both bladder and bowel incontinence, erectile dysfunction and some residual numbness and weakness in his left leg.

Having obtained and reviewed the medical records, Blake Lapthorn sought independent expert opinion from a consultant orthopaedic surgeon, who in turn sought input from a consultant radiologist. The experts concluded that there had been clear signs of cauda equina compression caused by an evolving haematoma during the post-operative period and that these had been missed by Mr H's treating clinicians.  A further supportive report was subsequently obtained form a consultant neurosurgeon.  On the basis of these reports, Blake Lapthorn sent a Letter of Claim to the Defendant hospital NHS Trust

Protective proceedings had to be issued before the Letter of Response was received.  This denied both breach of duty and causation.  The Defendant alleged that the injuries had been caused during the surgery, which was a recognised and non-negligent complication of the procedure.  It further denied that the post-operative MRI scan showed a haematoma compressing the thecal sac.

Accordingly a condition and prognosis report was obtained and Court proceedings were served.  The Defendant then filed a formal Defence but also made an early Part 36 offer, which was rejected as being unrealistically low.  In its Defence, it was conceded that Mr H's symptoms of cauda equine syndrome should have been recognised by 8pm on 7 January 2007 (but no earlier), but the Defendant contended that the cauda equine lesion was already complete by this time and therefore surgical intervention would have made no difference in any event.

The medical experts advised that Mr H was not fit to continue with roofing and building and would most likely not be insurable due to his condition.  Mr H had tried his utmost to continue working in spite of his injuries, to support his family.  However, urinary incontinence caused practical difficulties when attending private jobs and in reality, Mr H was not able to carry out anywhere near as much roofing work as he had prior to his surgery, despite the improvement in back pain.  Mr H was also involved in another business with family members and put his efforts into this, although the long-term market for such a business was really unclear.  Mr H's injuries caused him to be easily fatigued and during Blake Lapthorn's dealings with Mr H and his family, it became clear that he was suffering symptoms of depression.  These factors in combination meant that Mr H was unable to help around the home as much as he had done previously and at times required additional care himself.

Blake Lapthorn sought further reports on condition, prognosis and quantum from experts in psychiatry, forensic accounting, care and rehabilitation, colorectal surgery and urology.  Mr H's full schedule of financial loss was calculated to be in the region of £390,000 plus general damages of a further £70,000 - £80,000.

The case was due to be set down for a seven day trial.  However, in April 2011, shortly before exchange of expert evidence, the Defendant admitted breach of duty in relation to the failure to act sooner on the signs of cauda equina syndrome and conceded that Mr H would not have gone on to develop bowel and bladder problems and erectile dysfunction.  A Part 36 offer of £360,000 was made.  After a brief period of further negotiation, settlement was agreed in the sum of £400,000 plus reasonable costs.

Kym Provan, a senior solicitor in the Clinical Negligence team at Blake Lapthorn who represented Mr H, said: "Mr H was delighted with the settlement, which will allow him to work within his physical capabilities, most likely for significantly fewer hours.  He is also now able to plan to undergo surgery for the bladder operation without the financial worry over a long recovery period.  The family will be able to pay for help around the home where needed so that they can begin to enjoy their family life together again."


For further information, or if you have sustained a similar injury, please contact Kym on 023 8085 7317 or at kym.provan@bllaw.co.uk. Alternatively, please fill in our Contact form and we will call you back.