Abstract
INTRODUCTION
Cauda equina syndrome (CES) is a spinal emergency with clinical symptoms and signs that have low diagnostic accuracy. National guidelines in the United Kingdom (UK) state that all patients should undergo an MRI prior to referral to specialist spinal units and surgery, if required, should be performed at the earliest opportunity. We aimed to evaluate the current practice of investigating and treating suspected CES in the UK.
METHODS
A retrospective, multicentre observational study of the investigation and management of patients with suspected CES was conducted across the UK, including all patients referred to a spinal unit over 6 mo between 1st October 2016 and 31st March 2017.
RESULTS
A total of 28 UK spinal units submitted data on 4441 referrals. Over half of the referrals were made without any previous imaging (n = 2572, 57.9%). The majority of referrals were made out-of-hours (n = 2229/3517, 63.4%), of which 2.9% (n = 45/1529) underwent surgical decompression. Patient location and prereferral imaging were not significantly associated with time intervals from symptom onset or presentation to decompression. Patients investigated outside of the spinal unit experienced significantly longer time intervals from presentation and from referral to undergoing the MRI scan.
CONCLUSION
This is the largest known study of the investigation and management of suspected CES. We found that the majority of referrals were made without adequate investigations. Most patients were referred out-of-hours and many were transferred for an MRI without subsequently requiring surgery. Cases not transferred experienced delays if undergoing an MRI scan outside of the spinal unit.
