The evaluation of the clinical presentation, MRI findings and immediate management of potential cauda equina syndrome referrals in a tertiary neurosurgical centre

Abstract BACKGROUND AND IMPORTANCE: We present a rare case of a rectothecal fistula arising from an anterior sacral meningocele in a patient with Currarino syndrome. CLINICAL PRESENTATION: The patient was a 40-year-old woman presenting with cauda equina syndrome and ascending meningitis. The meningocele was removed using an anterior abdominal approach. A sigmoid resection was performed with rectal on-table antegrade lavage followed by closure of the rectal fistula, closure of the rectal stump, and proximal colostomy. Closure of the sacral deficit was carried out by suturing a strip of well-vascularized omentum and fibrin glue. CONCLUSION: We discuss the characteristics, management, and evolution of this unusual case. Prompt surgical management using an anterior approach, resection of the sac, closure of the sacral deficit, and fecal diversion resulted in a satisfactory outcome.

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Literature Review and Clinical Presentation of Pelvic Impalement by Steel Bar Causing Cauda Equina Syndrome

Neurosurgery Quarterly ◽

10.1097/wnq.0000000000000006 ◽

2015 ◽

Vol 25 (1) ◽

pp. 124-127

Author(s):

Junwu Ye ◽

Qingquan Kong ◽

Tianfu Yang

Keyword(s):

Literature Review ◽

Cauda Equina Syndrome ◽

Clinical Presentation ◽

Cauda Equina ◽

Steel Bar

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1499 The Statistical Value of Different Clinical Characteristics in Evaluation of Suspected Cauda Equina Syndrome

British Journal of Surgery ◽

10.1093/bjs/znab259.1058 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

W Levitt ◽

B Kamalakannan ◽

Y Leung

Keyword(s):

Back Pain ◽

Cauda Equina Syndrome ◽

Pain Sensitivity ◽

Cauda Equina ◽

Leg Pain ◽

Statistical Association ◽

Mri Findings ◽

Leg Weakness ◽

Red Flag ◽

One Year

Abstract Introduction Cauda Equina Syndrome(CES) is a potentially disabling condition caused by compression of the thecal sac in the lumbar spine. Traditional teaching suggests red flags include back pain, sciatica, saddle anaesthesia and bladder disturbance. Current guidelines from the British Association of Spinal Surgeons recommend prompt investigation with MRI should these symptoms be present. Method A retrospective electronic case note review was undertaken from a one-year period to identify patients referred to the on call orthopaedic team with suspected CES and were investigated with MRI. Notes were reviewed for the presence of each clinical characteristic and correlated with MRI findings. Results 334 referrals underwent urgent MRI with 25 scans showing CES. Poor statistical association was observed with unilateral leg pain (sensitivity 0.28, specificity 0.48), back pain (sensitivity 0.92, specificity 0.13) and bladder dysfunction (sensitivity 0.72, specificity 0.36). Much closer statistical association was seen with bilateral leg pain (sensitivity 0.6, specificity 0.7, OR 5.03, 95% CI 2.16-11.68, p0.0002), leg weakness (sensitivity 0.68, specificity of 0.72, OR 5.35, 95% CI 2.23-12.85, p0.0002), leg sensory deficit (sensitivity 0.72, specificity 0.60, OR 3.79, 95% CI 1.54-9.36, p0.004) and altered perianal sensation (sensitivity 0.6, specificity 0.67, OR 3.03, 95% CI 1.31-6.99, p 0.009) Conclusions The diagnostic accuracy for some conventional red flag characteristics in CES is low. In our series back pain, unilateral sciatica and bladder disturbance showed low predictive value while bilateral sciatica, saddle anesthesia and lower limb sensorimotor deficits showed closer association and therefore should be closely evaluated for when reviewing such patients.

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Management of Cauda Equina Syndrome: NHS Staff Perceptions in a DGH

Journal of Orthopedics & Bone Disorders ◽

10.23880/jobd-16000199 ◽

2020 ◽

Vol 4 (2) ◽

pp. 1-10

Author(s):

G Taylor

Keyword(s):

Cauda Equina Syndrome ◽

Empirical Studies ◽

Cauda Equina ◽

Nominal Group Technique ◽

Lower Limbs ◽

Nominal Group ◽

Poor Correlation ◽

Mri Findings ◽

Staff Perceptions ◽

Validated Questionnaire

Objective: Cauda Equina Syndrome (CES) is a challenging condition to diagnose due to such variability in clinical features and poor correlation with MRI findings. It requires surgery within hours to avoid damage to the bowel, bladder, sexual organs and lower limbs. There are empirical studies exploring patients’ perspectives of having CES, however, there is no literature to review NHS staff perceptions of managing this neurosurgical emergency. The aim is to explore perceptions of senior clinical staff who commonly manage patients with suspected CES in secondary care within the Emergency Department (ED) and Trauma and Orthopaedics (T&O) to improve the management of CES. The main objective is to identify barriers to successful management and possible solutions to improve care. Methods: A self-administered non-validated questionnaire was designed to identify barriers experienced and potential solutions. In addition, a Nominal Group Technique (NGT) was used to gain a greater insight. The qualitative data obtained was analysed by thematic analysis. Results: The questionnaire generated a 73% response rate. Six senior clinicians attended the NGT with representation from the three clinical specialities; ED, T&O and Advanced Physiotherapy Practitioner (APP). The challenges and potential solutions were categorised into themes and subthemes. The barriers highlighted included; staff confidence in clinical diagnosis; fear of litigation and inter-professional relations; patient psychosocial factors, expectations and comorbidities; lack of agreed local pathway. The solutions raised include; staff training; standardising local/national pathway; access to daily Magnetic Resonance Imaging (MRI) slots. Conclusion: Patient safety and accurate diagnosis of CES is at the forefront of decision-making despite organisation barriers and limitations of existing pathways. A shift away from admission to expedite an urgent MRI requires a change to traditional clinical practice and expectations. In times of rising pressures and financial constraints, collaborative working is essential to implement and sustain the required changes highlighted in this study.

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Lumbar Intraspinal Osteolipoma Presenting as Cauda Equina Syndrome: A Case Report and Review of Literature

Case Reports in Orthopedics ◽

10.1155/2018/1945149 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

S. Dilip Chand Raja ◽

Rishi Mugesh Kanna ◽

Ajoy Prasad Shetty ◽

S. Rajasekaran

Keyword(s):

Cauda Equina Syndrome ◽

Clinical Presentation ◽

Facet Joint ◽

Single Case ◽

Cauda Equina ◽

Good Prognosis ◽

Review Of Literature ◽

Pertinent Literature ◽

En Bloc ◽

Case Presentation

Introduction. Osteolipomas are uncommon variants of lipoma. These lesions have been usually reported to arise from the oral cavity, brain, and neck and scarcely from the knee and thigh. Intraspinal osteolipomas are rare. A single case of intraspinal osteolipoma has been reported in the cervical and thoracic spine in the literature. To our knowledge, there is no report of osteolipomas in the lumbar spine. Case Presentation. We report a very rare case of a solitary lumbar intraspinal osteolipoma, presenting as a cauda equina syndrome. The intraspinal osteolipoma was excised en bloc and fusion was performed as it required partial resection of the facet joint within 24 hours of presentation. He has since then improved neurologically, and there has been no recurrence of the lesion so far. The clinical presentation, radiological characteristics, treatment course, and histopathological features of this lesion along with the clinical outcomes and a pertinent literature review were done and have been discussed. Discussion. The heterogeneous signal intensity of the lesion in MRI differentiates it from other dural-based lesions, and this should raise suspicion of an osteolipoma, which warrants a CT. Although intraspinal osteolipomas are benign lesions and generally have good prognosis, they need to be removed en bloc as they may result in rapid neurological deterioration.

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Cystic Dilation of the Conus Ventriculus Terminalis Presenting as an Acute Cauda Equina Syndrome Relieved by Decompression and Cyst Drainage: Case Report

Neurosurgery ◽

10.1227/01.neu.0000197486.65781.88 ◽

2006 ◽

Vol 58 (3) ◽

pp. E585-E585 ◽

Cited By ~ 16

Author(s):

Jonathan L. Brisman ◽

Maria Li ◽

Dean Hamilton ◽

Marc R. Mayberg ◽

David W. Newell

Keyword(s):

Lower Extremity ◽

Cauda Equina Syndrome ◽

Clinical Presentation ◽

Cauda Equina ◽

Clinical Results ◽

Surgical Decompression ◽

Cystic Dilatation ◽

Simple Cyst ◽

Lower Extremity Weakness ◽

Lower Extremity Strength

Abstract OBJECTIVE AND IMPORTANCE: The ventriculus terminalis of the conus, or "fifth ventricle" refers to the ependymal-lined space in the middle of the conus that is present in childhood and whose persistence into adulthood is rare. A number of cases of cystic dilatation of the ventriculus terminalis have been described in adulthood. Patients tend to present with either pain alone or gradually progressive conus or cauda equina syndromes with varying degrees of recovery after cyst drainage. Presentation with an acute cauda equina syndrome and its successful surgical management has not been previously reported. CLINICAL PRESENTATION: A 57-year-old woman experienced back pain and bilateral sciatica ascribed to diabetic neuropathy for 2 years. Over a 24-hour period she developed bilateral lower extremity weakness, saddle anesthesia, and bowel and bladder incontinence. Lumbosacral magnetic resonance imaging demonstrated a large cystic dilatation of the ventriculus terminalis. INTERVENTION: She was taken for emergency surgical decompression and cyst drainage. Immediately after surgery, she experienced significant increase in lower extremity strength and has since regained continence. CONCLUSION: Cystic dilation of the ventriculus terminalis should be part of the differential diagnosis for a cauda equina syndrome; surgical decompression with simple cyst drainage can result in excellent clinical results.

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