scholarly journals Understanding cauda equina syndrome: protocol for a UK multicentre prospective observational cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e025230 ◽  
Author(s):  
Julie Woodfield ◽  
Ingrid Hoeritzauer ◽  
Aimun A B Jamjoom ◽  
Savva Pronin ◽  
Nisaharan Srikandarajah ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cauda Equina Syndrome ◽  
Management Practices ◽  
Cauda Equina ◽  
National Standards ◽  
Standards Of Care ◽  
Limb Weakness ◽  
Study Results ◽  
Patient Reported ◽  
The Uk

IntroductionCauda equina syndrome (CES) is a potentially devastating condition caused by compression of the cauda equina nerve roots. This can result in bowel, bladder and sexual dysfunction plus lower limb weakness, numbness and pain. CES occurs infrequently, but has serious potential morbidity and medicolegal consequences. This study aims to identify and describe the presentation and management of patients with CES in the UK.Methods and analysisUnderstanding Cauda Equina Syndrome (UCES) is a prospective and collaborative multicentre cohort study of adult patients with confirmed CES managed at specialist spinal centres in the UK. Participants will be identified using neurosurgical and orthopaedic trainee networks to screen referrals to spinal centres. Details of presentation, investigations, management and service usage will be recorded. Both patient-reported and clinician-reported outcome measures will be assessed for 1 year after surgery. This will establish the incidence of CES, current investigation and management practices, and adherence to national standards of care. Outcomes will be stratified by clinical presentation and patient management. Accurate and up to date information about the presentation, management and outcome of patients with CES will inform standards of service design and delivery for this important but infrequent condition.Ethics and disseminationUCES received a favourable ethical opinion from the South East Scotland Research Ethics Committee 02 (Reference: 18/SS/0047; IRAS ID: 233515). All spinal centres managing patients with CES in the UK will be encouraged to participate in UCES. Study results will be published in medical journals and shared with local participating sites.Trial registration numberISRCTN16828522; Pre-results.

Author Response: Scan-Negative Cauda Equina Syndrome: A Prospective Cohort Study

Neurology ◽  
2021 ◽  
Vol 97 (9) ◽  
pp. 456-457
Author(s):  
Ingrid Hoeritzauer ◽  
Alan Carson ◽  
Patrick Statham ◽  
Andreas Demetriades ◽  
Jon Stone
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Author Response

scholarly journals An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome

2019 ◽  
Vol 161 (9) ◽  
pp. 1887-1894 ◽  
Author(s):  
J. E. Hazelwood ◽  
I. Hoeritzauer ◽  
S. Pronin ◽  
A. K. Demetriades
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Long Term Outcomes ◽  
Patient Reported

scholarly journals The prevalence of serious pathology in musculoskeletal physiotherapy patients – a nationwide register-based cohort study

2020 ◽  
Author(s):  
Cecilie Budtz ◽  
Rikke Pilegaard Hansen ◽  
Janus Nikolaj Laust Thomsen ◽  
David Høyrup Christiansen
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Cauda Equina Syndrome ◽  
Previous History ◽  
Cauda Equina ◽  
Spinal Fracture ◽  
Malignant Neoplasms ◽  
Musculoskeletal Conditions ◽  
National Patient ◽  
Years Lived With Disability

Abstract Background: Musculoskeletal conditions are the single largest contributor to years lived with disability worldwide. Most musculoskeletal conditions can be managed and treated in primary care, but for a small proportion of these patients the symptoms are caused by serious pathology. Although the general practitioner usually performs initial screening for serious pathology, evaluation and treatment by physiotherapists are often part of the treatment pathway. It is however unclear, how many patients in primary care physiotherapy have symptoms caused by a serious pathology. Historically the prevalence of serious pathology in primary care has been investigated in small populations with spine specific conditions, thus a more general prevalence in the group of patients with musculoskeletal conditions is yet to be estimated. Therefore, the aim of this study was to estimate the prevalence of neoplasm, cauda equina syndrome, spinal fracture, infection and inflammatory pathology among patients referred for musculoskeletal physiotherapy evaluation and treatment.Methods: The study was a prospective nationwide register-based cohort study. We identified all referrals for primary care musculoskeletal physiotherapy in the Danish National Health Insurance Service Register between 1 January 2014 and 31 December 2017. Records of hospital contacts were extracted from the Danish National Patient Register within 180 days from first physiotherapy contact, identifying all diagnoses of serious pathology. Period prevalence proportions with 95%CI of the serious pathology categories were estimated. Results: A total of 1,568,704 courses of treatment were included in the analysis. The overall prevalence of serious pathology was 2.30%.The prevalence of neoplasm was 2.11%, of which 1.13% was malignant neoplasms. The prevalence of cauda equina syndrome was 0.01%, fractures 0.13%, infections 0.01% and inflammatory pathology of the spine 0.06%. Higher prevalence's were observed among patients with a previous history of serious pathology, aged above 50 and more comorbidity. Conclusions: Although serious pathology among musculoskeletal physiotherapy patients is rare, the present study found an overall prevalence of serious pathology which exceeded the guideline endorsed prevalence estimates of serious pathology of 1%.

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.

Standards of care in cauda equina syndrome

2016 ◽  
Vol 30 (5) ◽  
pp. 518-522 ◽  
Author(s):  
N. V. Todd ◽  
R. A. Dickson
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Standards Of Care

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.

Limited sequence MRI to improve standards of care for suspected cauda equina syndrome

2020 ◽  
Vol 102-B (4) ◽  
pp. 501-505 ◽  
Author(s):  
Ramal Gnanasekaran ◽  
Nicholas Beresford-Cleary ◽  
Tariq Aboelmagd ◽  
Karim Aboelmagd ◽  
Daniel Rolton ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Standards Of Care ◽  
Safety And Efficacy ◽  
Cauda Equina Compression ◽  
Mri Scans ◽  
Symptoms And Signs ◽  
Limited Sequence ◽  
Musculoskeletal Radiologist ◽  
Rule Out

Aims Early cases of cauda equina syndrome (CES) often present with nonspecific symptoms and signs, and it is recommended that patients undergo emergency MRI regardless of the time since presentation. This creates substantial pressure on resources, with many scans performed to rule out cauda equina rather than confirm it. We propose that compression of the cauda equina should be apparent with a limited sequence (LS) scan that takes significantly less time to perform. Methods In all, 188 patients with suspected CES underwent a LS lumbosacral MRI between the beginning of September 2017 and the end of July 2018. These images were read by a consultant musculoskeletal radiologist. All images took place on a 3T or 1.5T MRI scanner at Stoke Mandeville Hospital, Aylesbury, UK, and Royal Berkshire Hospital, Reading, UK. Results The 188 patients, all under the age of 55 years, underwent 196 LS lumbosacral MRI scans for suspected CES. Of these patients, 14 had cauda equina compression and underwent emergency decompression. No cases of CES were missed. Patients spent a mean 9.9 minutes (8 to 10) in the MRI scanner. Conclusion Our results suggest that a LS lumbosacral MRI could be used to diagnose CES safely in patients under the age of 55 years, but that further research is needed to assess safety and efficacy of this technique before changes to existing protocols can be recommended. In addition, work is needed to assess if LS MRIs can be used throughout the spine and if alternative pathology is being considered. Cite this article: Bone Joint J 2020;102-B(4):501–505.

349 Improving Assessment of Patients with Suspected Cauda Equina Syndrome Using A Standardised Proforma

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Ramasubbu ◽  
R Ahlo ◽  
Q Liao ◽  
K Periasamy
Keyword(s):  
Urinary Incontinence ◽  
Statistical Analysis ◽  
Patient Care ◽  
Faecal Incontinence ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Regional Level ◽  
Standards Of Care ◽  
Chi Squared ◽  
Enhance Patient Care

Abstract Introduction Cauda Equina Syndrome (CES) has a devastating impact on the life of affected individuals. Most patients are reviewed by doctors who do not have specialist spinal expertise. NHS Lanarkshire guidelines for CES are based on ‘Standards of Care in Cauda Equina Syndrome’ (Todd and Dickson) 2016. Method Documented assessment of a sample of patients with suspected CES in our hospital was audited against standards set in regional guidelines. A tick-box proforma was introduced to standardise assessment, with re-audit thereafter. Chi-squared was used for statistical analysis. Results Cycle 1 (2018): Documented assessment of findings in 30 patients - bilateral radiculopathy (80%), urinary incontinence (93%), faecal incontinence (73%), anal tone (93%), saddle anaesthesia (83%), bladder volumes (90%) and ASIA chart (20%). Cycle 2 (2019): Documented assessment of above findings was 100% in patients where a proforma was used. Proforma was used in 81% of patients. Conclusions Use of a standardised proforma improved assessment of CES. There was a statistically significant improvement in use of an ASIA chart (P < 0.01) and assessment of faecal incontinence (P = 0.039). Compliance with use of this proforma could be improved further, to enhance patient care. Following the success of the proforma, it is being reviewed for implementation on a regional level.

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