A prospective study of the role of bladder scanning and post-void residual volume measurement in improving diagnostic accuracy of cauda equina syndrome

2020 ◽  
Vol 102-B (6) ◽  
pp. 677-682
Author(s):  
Galateia Katzouraki ◽  
Akbar Jaleel Zubairi ◽  
Oded Hershkovich ◽  
Michael P. Grevitt
Keyword(s):  
Risk Stratification ◽  
Prospective Study ◽  
Clinical Assessment ◽  
Predictive Value ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Cost Savings ◽  
Volume Measurement ◽  
Cauda Equina Compression ◽  
Mri Scans

Aims Diagnosis of cauda equina syndrome (CES) remains difficult; clinical assessment has low accuracy in reliably predicting MRI compression of the cauda equina (CE). This prospective study tests the usefulness of ultrasound bladder scans as an adjunct for diagnosing CES. Methods A total of 260 patients with suspected CES were referred to a tertiary spinal unit over a 16-month period. All were assessed by Board-eligible spinal surgeons and had transabdominal ultrasound bladder scans for pre- and post-voiding residual (PVR) volume measurements before lumbosacral MRI. Results The study confirms the low predictive value of ‘red flag’ symptoms and signs. Of note ‘bilateral sciatica’ had a sensitivity of 32.4%, and a positive predictive value (PPV) of only 17.2%, and negative predictive value (NPV) 88.3%. Use of a PVR volume of ≥ 200 ml was a demonstrably more accurate test for predicting cauda equina compression on subsequent MRI (p < 0.001). The PVR sensitivity was 94.1%, specificity 66.8%, PPV 29.9% and NPV 98.7%. The PVR allowed risk-stratification with 13% patients deemed ‘low-risk’ of CES. They had non-urgent MRI scans. None of the latter scans showed any cauda equina compression (p < 0.006) or individuals developed subsequent CES in the intervening period. There were considerable cost-savings associated with the above strategy. Conclusion This is the largest reported prospective evaluation of suspected CES. Use of the PVR volume ≥ 200 ml was considerably more accurate in predicting CES. It is a useful adjunct to conventional clinical assessment and allows risk-stratification in managing suspected CES. If adopted widely it is less likely incomplete CES would be missed. Cite this article: Bone Joint J 2020;102-B(6):677–682.

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.

A Polyostotic Paget’s Disease Involving Lumbar Spine Presenting with Cauda Equina Syndrome: An Unusual Entity

2021 ◽  
Vol 11 (10) ◽  
Author(s):  
Shailesh Hadgaonkar ◽  
Shaunak Patwardhan ◽  
Pramod Bhilare ◽  
Parag Sancheti ◽  
Ashok Shyam
Keyword(s):  
Lumbar Spine ◽  
Neurological Deficit ◽  
Cauda Equina Syndrome ◽  
Indian Subcontinent ◽  
Paget’S Disease ◽  
Cauda Equina ◽  
Neurological Complications ◽  
Paget's Disease ◽  
Metabolic Bone ◽  
Cauda Equina Compression

Introduction:Paget’s disease of bone (PDB) is a metabolic bone disease presenting as polyostotic or monostotic lesions of the spine. Although common in the Anglo-Saxon population, it is rare on the Indian subcontinent. Neurological complications though infrequent can be severe in pagetic spine. Case Report:We report a case of a polyostotic variant of PDB involving lumbar spine (L2 vertebrae), iliac bones, and femur presenting as chronic low back pain and neurological deficit, i.e., cauda equina syndrome. On initial workup, a diagnosis of PDB was made and given cauda equina compression with neurological deficit, posterior spinal decompression, and biopsy was performed. The histopathological evaluation confirmed the diagnosis and the patient was treated with bisphosphonates for 6 months, along with serial monitoring of alkaline phosphatase levels. Conclusion:Through this case report, we hope to emphasize that PDB should be considered as a possible cause of neurological symptoms at presentation, especially in elderly patients. Also furthermore, early surgical intervention followed by bisphosphonates therapy can lead to favorable outcomes in such patients. Keywords:Polyostotic, Paget’s disease, cauda equine syndrome, lumbar spine.

Bladder Scans and Postvoid Residual Volume Measurement Improve Diagnostic Accuracy of Cauda Equina Syndrome

Spine ◽  
2019 ◽  
Vol 44 (18) ◽  
pp. 1303-1308 ◽  
Author(s):  
Muralidharan Venkatesan ◽  
Luigi Nasto ◽  
Magnum Tsegaye ◽  
Michael Grevitt
Keyword(s):  
Diagnostic Accuracy ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Volume Measurement ◽  
Residual Volume ◽  
Postvoid Residual ◽  
Postvoid Residual Volume

Predictive value of clinical characteristics in patients with suspected cauda equina syndrome

2009 ◽  
Vol 16 (3) ◽  
pp. 416-419 ◽  
Author(s):  
P. M. Domen ◽  
P. A. Hofman ◽  
H. van Santbrink ◽  
W. E. J. Weber
Keyword(s):  
Predictive Value ◽  
Cauda Equina Syndrome ◽  
Clinical Characteristics ◽  
Cauda Equina

scholarly journals ‘Scan-negative’ cauda equina syndrome: what to do when there is no neurosurgical cause

2021 ◽  
pp. practneurol-2020-002830
Author(s):  
Ingrid Hoeritzauer ◽  
Biba Stanton ◽  
Alan Carson ◽  
Jon Stone
Keyword(s):  
Differential Diagnosis ◽  
Clinical Features ◽  
Acute Pain ◽  
Small Proportion ◽  
Neurological Disorder ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Common Presentation ◽  
Cauda Equina Compression ◽  
Functional Neurological Disorder

Suspected cauda equina syndrome is a common presentation in emergency departments, but most patients (≥70%) have no cauda equina compression on imaging. As neurologists become more involved with ‘front door’ neurology, referral rates of patients with these symptoms are increasing. A small proportion of patients without structural pathology have other neurological causes: we discuss the differential diagnosis and how to recognise these. New data on the clinical features of patients with ‘scan-negative’ cauda equina syndrome suggest that the symptoms are usually triggered by acute pain (with or without root impingement) causing changes in brain–bladder feedback in vulnerable individuals, exacerbated by medication and anxiety, and commonly presenting with features of functional neurological disorder.

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.

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