The morbidity of out-of-hours surgery for Cauda Equina Syndrome

2022 ◽  
pp. 1-4
Author(s):  
Aditaya Kumar ◽  
Phil Copley ◽  
Aimun Jamjoom ◽  
Khaled Badran ◽  
Christopher Barrett
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Out Of Hours

Evaluation of Nationwide Referral Pathways, Investigation and Treatment of Suspected Cauda Equina Syndrome in the United Kingdom (ENTICE)

Neurosurgery ◽  
2019 ◽  
Vol 84 (5) ◽  
pp. E271-E271 ◽  
Author(s):  
Dillon Vyas ◽  
Keyword(s):  
United Kingdom ◽  
Cauda Equina Syndrome ◽  
Clinical Symptoms ◽  
Cauda Equina ◽  
National Guidelines ◽  
Time Intervals ◽  
Mri Scan ◽  
Out Of Hours ◽  
The United Kingdom ◽  
The Uk

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.

scholarly journals The Value of Interhospital Transfer and Emergency MRI for Suspected Cauda Equina Syndrome: A 2-Year Retrospective Study

2008 ◽  
Vol 90 (6) ◽  
pp. 513-516 ◽  
Author(s):  
M Crocker ◽  
G Fraser ◽  
E Boyd ◽  
J Wilson ◽  
BP Chitnavis ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Pain Syndrome ◽  
Working Hours ◽  
Out Of Hours ◽  
Interhospital Transfer ◽  
Mri Scans ◽  
Prolapsed Intervertebral Disc ◽  
Magnetic Resonance Imaging Mri ◽  
The Uk

INTRODUCTION The timing of surgery in cauda equina syndrome due to prolapsed intervertebral disc remains controversial. Assessment of these patients requires magnetic resonance imaging (MRI), which is of limited availability outside normal working hours in the UK. PATIENTS AND METHODS We reviewed radiological results in all patients undergoing emergency MRI within our unit for suspected cauda equina syndrome over a 2-year period, and all subjects undergoing emergency lumbar discectomy for cauda equina syndrome within the same period. Outcome measures were: proportion of positive findings in symptomatic patients and proportion of patients referred with diagnostic MRI scans undergoing emergency surgery. We also assessed outcomes of patients having surgery for cauda equina syndrome in terms of improvement of pain, sensory and sphincter disturbance. RESULTS A total of 76 patients were transferred for assessment and ‘on-call’ MRI; 27 were subsequently operated upon. Only 5 proceeded to emergency discectomy that night (prior to next scheduled list). This may be due to delays in timing – from referral to acceptance, to arrival in the department, to diagnostic scan and to theatre. With the second group of patients, 43 had emergency discectomy for cauda equina syndrome during the study period. Of these, 6 patients had an out-of-hours MRI at our hospital for assessment (one patient living locally). Most surgically treated patients experienced improvement in their pain syndrome, with approximately two-thirds experiencing improvement in sensory and sphincter disturbance. CONCLUSIONS These data support a policy of advising MRI scan for cauda equina syndrome at the earliest opportunity within the next 24 h in the referring hospital, rather than emergency transfer for diagnostic imaging which has a relatively low yield in terms of patients operated on as an emergency.

scholarly journals A scoping review protocol: Investigating the extent and legal process of cauda equina syndrome claims for UK physiotherapists

2021 ◽  
Author(s):  
Rachel L. Leech ◽  
James Selfe ◽  
Suzanne Ball ◽  
Susan Greenhalgh ◽  
Gareth Hogan ◽  
...  
Keyword(s):  
Scoping Review ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Legal Process ◽  
Review Protocol

scholarly journals Bilateral triceps surae muscle focal myositis after a cauda equina syndrome

2021 ◽  
Author(s):  
G.R. González Toledo ◽  
H. Pérez Pérez ◽  
L. Brage Martín ◽  
V. Castro López-Tarruella
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Triceps Surae ◽  
Triceps Surae Muscle

scholarly journals Acute bilateral foot drop with or without cauda equina syndrome—a case series

2021 ◽  
Vol 163 (4) ◽  
pp. 1191-1198
Author(s):  
Andreas K. Demetriades ◽  
Marco Mancuso-Marcello ◽  
Asfand Baig Mirza ◽  
Joseph Frantzias ◽  
David A. Bell ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Case Series ◽  
Foot Drop ◽  
Spinal Disease ◽  
Full Resolution ◽  
Degenerative Spinal Disease ◽  
The Mean ◽  
The One

Abstract Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely rare neurosurgical presentation, whilst the literature is rich with accounts of chronic bilateral foot drop occurring as a sequela of systemic illnesses. We present, to our knowledge, the largest case series of acute bilateral foot drop, with trauma and relevant systemic illness excluded. Methods Data from three different centres had been collected at the time of historic treatment, and records were subsequently reviewed retrospectively, documenting the clinical presentation, radiological level of compression, timing of surgery, and degree of neurological recovery. Results Seven patients are presented. The mean age at presentation was 52.1 years (range 41–66). All patients but one were male. All had a painful radiculopathic presentation. Relevant discopathy was observed from L2/3 to L5/S1, the commonest level being L3/4. Five were treated within 24 h of presentation, and two within 48 h. Three had concomitant cauda equina syndrome; of these, the first two made a full motor recovery, one by 6 weeks follow-up and the second on the same-day post-op evaluation. Overall, five out of seven cases had full resolution of their ankle dorsiflexion pareses. One patient with 1/5 power has not improved. Another with 1/5 weakness improved to normal on the one side and to 3/5 on the other. Conclusion When bilateral foot drop occurs acutely, we encourage the consideration of degenerative spinal disease. Relevant discopathy was observed from L2/3 to L5/S1; aberrant innervation may be at play. Cauda equina syndrome is not necessarily associated with acute bilateral foot drop. The prognosis seems to be pretty good with respect to recovery of the foot drop, especially if partial at presentation and if treated within 48 h.

scholarly journals Surgical decompressions for cauda equina syndrome during COVID-19

2020 ◽  
pp. 1-3
Author(s):  
Nithish Jayakumar ◽  
Lucie Ferguson ◽  
Justin Nissen ◽  
Damian Holliman
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina

scholarly journals 307 Improving Compliance with Standard of Care Guidelines for Suspected Cauda Equina Syndrome Across A District General Hospital Network

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
D Richardson ◽  
F Greenway ◽  
A Mostofi ◽  
E Pereira
Keyword(s):  
Cauda Equina Syndrome ◽  
Guideline Implementation ◽  
Cauda Equina ◽  
Clinical Information ◽  
Standard Of Care ◽  
District General Hospital ◽  
Service Improvement ◽  
Local Policy ◽  
National Guidelines ◽  
Care Guidelines

Abstract Introduction Cauda equina syndrome (CES) is a spinal emergency that cannot be reliably detected through clinical examination alone and as a result requires prompt MR imaging to provide a diagnosis. This audit examined compliance to standard of care following service improvements in line with the updated SBNS/BASS national guidelines for CES. Method A retrospective analysis of 200 patients referred to neurosurgery for suspected CES: 100 pre- and 100 post-service improvement SBNS guideline implementation. The online neurosurgical database was reviewed, cases assessed for completeness of referral information (including appropriate exam and pre-referral MRI) with patient demographics, referring hospital and outcome also recorded. Results Prior to the SBNS guidelines only 19 patients received MRI prior to referral, 70% of all referrals were incomplete or contained erroneous clinical information. Post-service improvements there was a 68% increase of pre-referral MRI (32 cases), and an improvement in quality of clinical information with only 19% of referrals providing insufficient or unreliable information. Conclusions Through relatively simple changes to local policy, patient care flow and education of emergency department clinicians we have significantly improved pre-referral MRI rates as well as overall referral quality across the whole DGH network.

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