Factors Associated with Recovery in Motor Strength, Walking Ability, and Bowel and Bladder Function after Traumatic Cauda Equina Injury

Abstract Introduction Cauda Equina Syndrome (CES) is rare but when the diagnosis is delayed patient morbidity is significant. Recently, NICE Clinical Knowledge Summaries have updated their red flags on CES to be more explicit enabling earlier referral and diagnosis. A joint project between Orthopaedics and Radiology departments aimed to assess the current pathway of Cauda Equina Investigation at a District General Hospital. Method Data was collected from the local Radiology database for requests between July 2017 and August 2018. This included both direct requests to assess for CES and implied. Raw data revealed a potential of 600 patients, of which we have analysed 332 patients met the eligibility criteria. Results Only 58 patients had a documented complete bladder function assessment, of those 33% had incomplete or partial bladder emptying. Time to MRI scan ranged from 50mins – 23 hours & 52 mins. 47% had negative scans with CES or Cord compromise on MRI scan was demonstrated on 9%. 23 patients were transferred urgently to the receiving tertiary centre. Conclusions We found that nearly 90% of patients were being incompletely assessed and time to scan ranged significantly. We are producing a trust wide suspected CES pathway to improve patient assessment.

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Factors associated with change in walking ability in very elderly patients hospitalized for acute myocardial infarction

Geriatrics and Gerontology International ◽

10.1111/j.1447-0594.2007.00364.x ◽

2007 ◽

Vol 7 (1) ◽

pp. 21-25

Author(s):

Yoshihisa Hirakawa ◽

Yuichiro Masuda ◽

Masafumi Kuzuya ◽

Akihisa Iguchi ◽

Takaya Kimata ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Elderly Patients ◽

Walking Ability ◽

Very Elderly ◽

Factors Associated

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Factors associated with mobility apprehension in persons with lower limb amputation

Prosthetics and Orthotics International ◽

10.1177/0309364620915017 ◽

2020 ◽

Vol 44 (4) ◽

pp. 208-214

Author(s):

Shannon L Mathis

Keyword(s):

Standard Deviation ◽

Lower Limb ◽

Avoidance Behavior ◽

Pain Catastrophizing ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Walking Ability ◽

Factors Associated ◽

The Mean ◽

The Impact

Background: Factors that are related to mobility apprehension were measured in a sample of persons with lower-limb amputation. Objectives: The purpose was to determine whether intensity, interference, or catastrophizing are associated with mobility apprehension. Study design: Cross-sectional study. Methods: Persons with amputation of a lower limb who were attending a national limb loss conference were recruited to complete a survey. Subjects were administered the Tampa Scale for Kinesiophobia to measure mobility apprehension. The Brief Pain Inventory was administered to quantify the affect of pain on general activity, walking ability, and enjoyment of life. The Pain Catastrophizing Scale was administered to assess the tendency to ruminate and magnify pain sensations. A multivariable linear regression was performed to determine factors associated with mobility apprehension. Results: Fifty-three people with lower-limb amputation participated in the study. The mean (standard deviation) score for mobility apprehension was 34.2 (6.0). Mean (standard deviation) pain intensity and interference scores were 1.6 (1.7) and 2.5 (2.6), respectively. The mean (standard deviation) pain catastrophizing score was 9.1 (10). Pain catastrophizing was the only variable associated with higher mobility apprehension ( β = 0.31, p < 0.001, R2 = 0.32). Results suggest that for every one-point increase in the pain catastrophizing score, mobility apprehension will increase by 0.3 of a point. Conclusion: These preliminary results suggest that pain catastrophizing was related to mobility apprehension in this cohort of persons with lower-limb amputation. This relationship indicates that the exploration of avoidance behaviors, such as pain catastrophizing, may be useful when developing a program for physical rehabilitation. Clinical relevance Pain catastrophizing, an avoidance behavior, may be associated with higher levels of mobility apprehension in persons with major lower-limb amputation. Understanding the impact of fear-avoidance behavior will allow clinicians to identify individuals at risk for poor outcomes following amputation surgery and to develop psychological strategies to complement treatment.

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103. Factors associated with motor, sensory, bladder and bowel function recovery after traumatic cauda equina injury (TCEI)

The Spine Journal ◽

10.1016/j.spinee.2019.05.116 ◽

2019 ◽

Vol 19 (9) ◽

pp. S49-S50

Author(s):

Najmedden Attabib ◽

Colleen O'Connell ◽

Dilnur Kurban ◽

Carly S. Rivers ◽

Vanessa K. Noonan ◽

...

Keyword(s):

Cauda Equina ◽

Bowel Function ◽

Factors Associated ◽

Function Recovery

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Return of normal urological and neurological function after revision surgery for spondyloptosis

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.3.272 ◽

2007 ◽

Vol 6 (3) ◽

pp. 272-275

Author(s):

Sean M. Jones-Quaidoo ◽

Travis Hunt ◽

Christopher I. Shaffrey ◽

Vincent Arlet

Keyword(s):

Revision Surgery ◽

Cauda Equina ◽

Radicular Pain ◽

Bladder Function ◽

Posterior Decompression ◽

Index Procedure ◽

Dome Osteotomy ◽

Patient Reported ◽

Grade 3

✓ The authors report on the return of neurological and urological function in an adolescent after revision surgery for spondyloptosis 5 years after the index procedure for high-grade spondylolisthesis. This 16-year-old girl with Grade 3 spondylolisthesis was initially treated with a posterolateral reduction and fusion. Following surgery, cauda equina syndrome symptoms developed and did not resolve despite subsequent surgical decompression. Five years later, because of worsening radicular pain, an inability to walk for significant distances, and no resolution of persistent bladder dysfunction, the patient presented with spondyloptosis. Posterior decompression, sacral dome osteotomy, and posterior reduction were performed and followed 3 days later with the placement of an anterior fibula autograft. Her bladder function recovered within 6 months, and at the 18-month follow up the patient reported a normal ability to ambulate.

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Lateral extracavitary approach to traumatic lesions of the thoracic and lumbar spine

Journal of Neurosurgery ◽

10.3171/jns.1976.45.6.0628 ◽

1976 ◽

Vol 45 (6) ◽

pp. 628-637 ◽

Cited By ~ 221

Author(s):

Sanford J. Larson ◽

Robert A. Holst ◽

David C. Hemmy ◽

Anthony Sances

Keyword(s):

Spinal Cord ◽

Lumbar Spine ◽

Cauda Equina ◽

Gunshot Wounds ◽

Bladder Function ◽

Joint Rotation ◽

Content Type ◽

Primary Object ◽

Thoracic And Lumbar Spine ◽

Traumatic Lesions

✓ The lateral extracavitary approach to the spine was used for resection of displaced bone and disc located anterior to the dura in 62 patients with traumatic lesions of the thoracic and lumbar spine. Fifty-two patients had closed vertebral fractures and 10 had gunshot wounds. The spinal cord was involved in 44 patients, and the cauda equina in 18. A spinal subarachnoid block was demonstrated in 17 of 57 preoperative gas myelograms. Evoked potential recordings, although related to perception of joint rotation, tended to reflect the overall neurological condition and had some prognostic value. Significant improvement followed surgery in 46 patients with incomplete neurological lesions, and one was transiently worse. Before operation 18 patients were able to walk; nine with assistance and nine without. After operation 47 patients were able to walk; 12 with assistance and 35 without. Adequate bladder function was present in 17 patients before surgery, and in 44 after surgery. A laminectomy had been done previously in 16 patients, 11 of whom improved significantly after anterior resection. Spine fusions were required in 26 patients, five of whom had a prior laminectomy. The major factor in the pathogenesis of the incomplete neurological deficit appeared to be distortion of the cord and roots by displaced bone and disc. Consequently, the primary object of treatment was the restoration and maintenance of normal anatomical relationships between the spinal cord or cauda equina and the spinal canal.

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P31 Cauda equina syndrome – the importance of an early, accurate diagnosis and treatment in preventing bladder dysfunction

BJS Open ◽

10.1093/bjsopen/zrab032.030 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Victoria Amy Porter ◽

Victoria Porter

Keyword(s):

Urinary Retention ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Accurate Diagnosis ◽

Diagnostic Methods ◽

Diagnosis And Treatment ◽

Decompressive Surgery ◽

Bladder Function ◽

Urological Complications ◽

Significant Difference

Abstract Introduction Cauda Equina Syndrome (CES), is a neurological emergency with many urological features. Delayed decompressive surgery can cause urinary retention, overflow incontinence, long term catherization and loss of sexual function. This article focusses on the accuracy of the initial diagnosis and the time taken before treatment is commenced. Methods In this systematic literature review, OneSearch and PubMed have been searched for articles which identify the main symptoms of CES, evaluate the effectiveness of several diagnostic methods and compare the postoperative results of bladder function following timely and delayed treatment. Results A total of 20 articles have been referenced, of which 9 studies have been reviewed. While no individual symptom is 100% indicative of CES, urinary retention (diagnostic accuracy 0.9), is the most consistent clinical finding. Therefore, MRI is necessary for an accurate diagnosis. Further 4 out of 5 studies state that treatment within 24-hours improves patient outcomes compared to 48-hours, one study showed no significant difference between 24 and 48 hours. All articles indicate beyond 48-hours, surgical intervention has little impact on the relief of symptoms. Conclusion The studies concluded that any patient presenting in the emergency department with lower back pain should be screened for CES. A thorough history and neurological examination should be performed; however, the evidence base for rectal examination to assess anal tone is poor. Decompressive surgery carried out within the first 24-hour period from the onset of symptoms is favourable. Overall, early accurate diagnosis and treatment is invaluable to preventing urological complications and improving prognosis.

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Intradural iatrogenic epidermoid cyst at cauda equina: A case report

Surgical Neurology International ◽

10.25259/sni_417_2020 ◽

2020 ◽

Vol 11 ◽

pp. 299

Author(s):

Jose Javier Cuellar Hernandez ◽

Miracle Anokwute ◽

Silvia Judith Hernandez Martinez ◽

Jose Ramon Olivas

Keyword(s):

Epidermoid Cyst ◽

Spinal Dysraphism ◽

Cauda Equina ◽

Lower Extremity Weakness ◽

Epidermoid Cysts ◽

History Of ◽

Motor Strength ◽

Stratified Squamous Epithelium ◽

The Right ◽

Spinal Epidural

Background: Spinal epidermoid accounts for <1% of all primary spinal cord tumors. They occur due to the invagination of epidermal elements into the neural tube during the embryonic period. Even more infrequent are spinal epidermoid cysts that occur without attendant spinal dysraphism (e.g., as occurs with the iatrogenic inoculation of epithelial cells in the subarachnoid space following a lumbar puncture). Case Description: A 38-year-old female with a history of epidural spinal blocks at L2-3 for two previous pregnancies presented with low back pain, right lower extremity weakness (4/5 level), hyporeflexia, and tingling/ numbness in the right L3-5 distribution. The lumbar MR demonstrated an intradural extramedullary lesion at the L2-L3 level that compressed the cauda equina/nerve roots. MR findings were compatible with an epidermoid cyst, this was histologically confirmed following a microsurgical L2-3 laminectomy for lesion resection. Pathologically, the lesion demonstrated a keratinized stratified squamous epithelium with keratin content without cutaneous attachments, thus confirming the diagnosis of an epidermoid cyst. Postoperatively, her sensory complains improved and her motor strength fully recovered to the 5/5 level. Conclusion: Patients with spinal epidermoid cysts typically present with underlying spinal dysraphism, but only rarely do iatrogenic cases arise. Here, we presented a patient who developed a spinal lumbar epidermoid cyst in a female patient after undergoing spinal epidural anesthesia during pregnancy. Notably, this was successfully treated a with decompressive laminectomy and microsurgical resection.

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Evaluation of Outcome of Timing of Surgical Intervention on Cauda Equina Syndrome

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v20i1.26686 ◽

2021 ◽

Vol 20 (1) ◽

pp. 19-23

Author(s):

Rajesh Pratap Shah ◽

Bishnu Babu Thapa ◽

Sushil Rana Magar ◽

Ritesh Sinha ◽

Pankaj Chand ◽

...

Keyword(s):

Cauda Equina Syndrome ◽

Tertiary Care ◽

Cauda Equina ◽

Timing Of Surgery ◽

Bladder Function ◽

Delayed Presentation ◽

Inclusion Criteria ◽

Permanent Disability ◽

Number Of Patients

Introduction: Cauda equina syndrome (CES) is a rare clinical entity caused by compression of lumbar and sacral nerve roots resulting in various neurological dysfunctions. Early diagnosis of the syndrome and timely intervention is required to prevent permanent disability. Methods: This is a retrospective study conducted from January 2013 to December 2017 in a tertiary care centre in Kathmandu, Nepal. All the cases meeting the inclusion criteria were included in the study. Patients were operated using posterior open discectomy and the outcome was evaluated at two weeks , one month, three months, six months and one year. Result: Total number of patients meeting the inclusion criteria was 10, two females and eight males with a mean age of 40.30 + 6.58 years. The mean time for onset of symptom to timing of surgery was 142 hrs. VAS for leg improved from 5.90 + 0 .738 to 0.70 + 0.483 and VAS for back pain improved from 3.20 + 1.476 to 0.5 + 0.572 post operatively. There was improvement in sensory and motor function in all the cases. Bowel and bladder function improved in all the cases postoperatively at the time of final follow up. Sexual function was impaired in six patients preoperatively but postoperatively four had improved and two patients had poor result at the time of final follow up. Conclusions: Timing of surgery may not be the most important determining factor for the outcome of the CES. Surgical decompression in delayed presentation have good clinical outcome in CES.

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Pyogenic Spondylodiscitis: Risk Factors for Adverse Clinical Outcome in Routine Clinical Practice

Medical Sciences ◽

10.3390/medsci6040096 ◽

2018 ◽

Vol 6 (4) ◽

pp. 96

Author(s):

John Widdrington ◽

Ingrid Emmerson ◽

Milo Cullinan ◽

Manjusha Narayanan ◽

Eleanor Klejnow ◽

...

Keyword(s):

Clinical Outcome ◽

Cauda Equina ◽

Neurological Impairment ◽

Adverse Outcomes ◽

Unfavourable Outcome ◽

Permanent Disability ◽

Duration Of Symptoms ◽

Factors Associated ◽

Pyogenic Spondylodiscitis ◽

Clinical Records

We aimed to describe the clinical features and outcomes of pyogenic spondylodiscitis and to identify factors associated with an unfavourable clinical outcome (defined as death, permanent disability, spinal instability or persistent pain). In our tertiary centre, 91 cases were identified prospectively and a retrospective descriptive analysis of clinical records was performed prior to binary regression analysis of factors associated with an unfavourable outcome. A median 26 days elapsed from the onset of symptoms to diagnosis and 51% of patients had neurological impairment at presentation. A microbiological diagnosis was reached in 81%, with Staphylococcus aureus most commonly isolated. Treatment involved prolonged hospitalisation (median stay 40.5 days), long courses of antibiotics (>6 weeks in 98%) and surgery in 42%. While this was successful in eradicating infection, only 32% of patients had a favourable clinical outcome and six patients (7%) died. Diabetes mellitus, clinical evidence of neurological impairment at presentation, a longer duration of symptoms and radiological evidence of spinal cord or cauda equina compression were independent factors associated with an unfavourable outcome. Our data indicate that spondylodiscitis is associated with significant morbidity and suggest that adverse outcomes may be predicted to an extent by factors present at the time of diagnosis.

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