scholarly journals Management of Cauda Equina Syndrome: NHS Staff Perceptions in a DGH

2020 ◽  
Vol 4 (2) ◽  
pp. 1-10
Author(s):  
G Taylor
Keyword(s):  
Cauda Equina Syndrome ◽  
Empirical Studies ◽  
Cauda Equina ◽  
Nominal Group Technique ◽  
Lower Limbs ◽  
Nominal Group ◽  
Poor Correlation ◽  
Mri Findings ◽  
Staff Perceptions ◽  
Validated Questionnaire

Objective: Cauda Equina Syndrome (CES) is a challenging condition to diagnose due to such variability in clinical features and poor correlation with MRI findings. It requires surgery within hours to avoid damage to the bowel, bladder, sexual organs and lower limbs. There are empirical studies exploring patients’ perspectives of having CES, however, there is no literature to review NHS staff perceptions of managing this neurosurgical emergency. The aim is to explore perceptions of senior clinical staff who commonly manage patients with suspected CES in secondary care within the Emergency Department (ED) and Trauma and Orthopaedics (T&O) to improve the management of CES. The main objective is to identify barriers to successful management and possible solutions to improve care. Methods: A self-administered non-validated questionnaire was designed to identify barriers experienced and potential solutions. In addition, a Nominal Group Technique (NGT) was used to gain a greater insight. The qualitative data obtained was analysed by thematic analysis. Results: The questionnaire generated a 73% response rate. Six senior clinicians attended the NGT with representation from the three clinical specialities; ED, T&O and Advanced Physiotherapy Practitioner (APP). The challenges and potential solutions were categorised into themes and subthemes. The barriers highlighted included; staff confidence in clinical diagnosis; fear of litigation and inter-professional relations; patient psychosocial factors, expectations and comorbidities; lack of agreed local pathway. The solutions raised include; staff training; standardising local/national pathway; access to daily Magnetic Resonance Imaging (MRI) slots. Conclusion: Patient safety and accurate diagnosis of CES is at the forefront of decision-making despite organisation barriers and limitations of existing pathways. A shift away from admission to expedite an urgent MRI requires a change to traditional clinical practice and expectations. In times of rising pressures and financial constraints, collaborative working is essential to implement and sustain the required changes highlighted in this study.

scholarly journals Late presentation of a cauda equina lesion with a vulval abscess: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Chanil Deshan Ekanayake ◽  
Deepal Weerasekera ◽  
Dilini Dissanayake ◽  
Ranga Wickramarachchi ◽  
Saman Pushpakumara ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Late Presentation ◽  
Surgical Decompression ◽  
Lower Limbs ◽  
Sensory Loss ◽  
Postoperative Rehabilitation ◽  
Indwelling Catheter ◽  
Distended Bladder ◽  
Tract Infections

Abstract Background Cauda equina syndrome is a rare clinical condition that requires prompt diagnosis and timely surgical decompression with postoperative rehabilitation to prevent devastating complications. Case presentation A 55-year-old Sinhalese woman presented with a vulval abscess, with a history of involuntary leakage of urine for the last 7 years. Her sexual activity has been compromised due to coital incontinence, and she had also been treated for recurrent urinary tract infections during the last 7 years. On examination, a distended bladder was found. Neurological examination revealed a saddle sensory loss of S2–S4 dermatomes. There was no sensory loss over the lower limbs. Bladder sensation was absent, but there was some degree of anal sphincter tone. Motor functions and reflexes were normal in the limbs. Magnetic resonance imaging revealed L5–S1 spondylolisthesis. Ultrasound imaging confirmed the finding of a distended bladder, in addition to bilateral hydroureters with hydronephrosis. An incision and drainage with concomitant intravenous antibiotics were started for the vulval abscess. An indwelling catheter was placed to decompress the bladder and to reduce vulval excoriations due to urine. Bilateral ureteric stenting was performed later for persistent hydronephrosis and hydroureter despite an empty bladder. Conclusion This is a tragic case that illustrates the devastating long-term sequelae that ensues if cauda equina syndrome is left undiagnosed. It reiterates the importance of prompt referral and surgical decompression.

scholarly journals Cauda equina syndrome due to Factor Xa inhibitor (Rivaroxaban): Case report and review of literature

2020 ◽  
Vol 7 (1) ◽  
pp. 7
Author(s):  
SR Gowda ◽  
PJ O’Hagan ◽  
JT Griffiths
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Factor Xa ◽  
Epidural Haematoma ◽  
Sudden Onset ◽  
Lower Limbs ◽  
Spontaneous Bleeding ◽  
Gradual Improvement ◽  
Spinal Epidural Haematoma ◽  
Spinal Epidural

Background: Factor Xa inhibitors are widely used by the physicians to reduce the incidence of thrombosis in order to protect the cardiovascular function. Although complications of bleeding and spontaneous gastrointestinal sources have been reported before, there are very sporadic cases of spinal epidural haematoma causing neurological compromise. Case presentation: We report a case of spontaneous spinal epidural haematoma (SSEH) in an 85-year-old female patient treated with Rivaroxaban, a new agent to prevent the incidence of thrombo-embolic events. Anticoagulant therapy is a recognised risk factor in the development of spontaneous bleeding and haematomas. The patient presented to the emergency department with sudden onset of severe back pain in the lumbar spine associated with paraplegia in the lower limbs. Magnetic resonance imaging (MRI) of the spine demonstrated a SSEH from T12 to L5 affecting the cauda equina. Rivaroxaban was discontinued and the patient was monitored as an inpatient. There was gradual improvement in the symptoms of the lower limbs. Conclusion: This rare condition of incomplete cauda equina syndrome due to Rivaroxaban therapy has not been reported previously. Clinicians must have a high index of suspicion in patients on regular anti-coagulation regimen.

scholarly journals 1499 The Statistical Value of Different Clinical Characteristics in Evaluation of Suspected Cauda Equina Syndrome

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
W Levitt ◽  
B Kamalakannan ◽  
Y Leung
Keyword(s):  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Pain Sensitivity ◽  
Cauda Equina ◽  
Leg Pain ◽  
Statistical Association ◽  
Mri Findings ◽  
Leg Weakness ◽  
Red Flag ◽  
One Year

Abstract Introduction Cauda Equina Syndrome(CES) is a potentially disabling condition caused by compression of the thecal sac in the lumbar spine. Traditional teaching suggests red flags include back pain, sciatica, saddle anaesthesia and bladder disturbance. Current guidelines from the British Association of Spinal Surgeons recommend prompt investigation with MRI should these symptoms be present. Method A retrospective electronic case note review was undertaken from a one-year period to identify patients referred to the on call orthopaedic team with suspected CES and were investigated with MRI. Notes were reviewed for the presence of each clinical characteristic and correlated with MRI findings. Results 334 referrals underwent urgent MRI with 25 scans showing CES. Poor statistical association was observed with unilateral leg pain (sensitivity 0.28, specificity 0.48), back pain (sensitivity 0.92, specificity 0.13) and bladder dysfunction (sensitivity 0.72, specificity 0.36). Much closer statistical association was seen with bilateral leg pain (sensitivity 0.6, specificity 0.7, OR 5.03, 95% CI 2.16-11.68, p0.0002), leg weakness (sensitivity 0.68, specificity of 0.72, OR 5.35, 95% CI 2.23-12.85, p0.0002), leg sensory deficit (sensitivity 0.72, specificity 0.60, OR 3.79, 95% CI 1.54-9.36, p0.004) and altered perianal sensation (sensitivity 0.6, specificity 0.67, OR 3.03, 95% CI 1.31-6.99, p 0.009) Conclusions The diagnostic accuracy for some conventional red flag characteristics in CES is low. In our series back pain, unilateral sciatica and bladder disturbance showed low predictive value while bilateral sciatica, saddle anesthesia and lower limb sensorimotor deficits showed closer association and therefore should be closely evaluated for when reviewing such patients.

scholarly journals GELFOAM INDUCED CAUDA EQUINA SYNDROME: A CASE REPORT WITH REVIEW OF LITERATURE

2020 ◽  
pp. 1-3
Author(s):  
Nazim Mughal ◽  
Deepankar Mishra ◽  
Ajay Srivastava ◽  
Nikhat Naaz
Keyword(s):  
Spinal Surgery ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Neurological Complications ◽  
Lumbar Discectomy ◽  
Lower Limbs ◽  
Gelatin Sponge ◽  
Review Of Literature ◽  
Hemostatic Agents ◽  
Dural Sac

Gelatin sponge (Gelfoam) is quite often used for haemostasis during spine surgery. However due to its property of osmotic expansion after coming in contact with blood, it has the potential to cause serious complications as a result of compression of nearby vital neurological tissues. We report a case of cauda equina syndrome due to retained Gelfoam during spinal surgery. A 35 year old female patient presented with complaints of pain and numbness in lower limbs for 5 months. MRI was suggestive of disc herniation at L4/L5. Lumbar discectomy was done and gelfoam was used for haemostasis. However, patient developed post-operative neurological complications suggestive of cauda equina syndrome. MRI showed gelfoam induced compression of dural sac. Gelfoam removal was done after which marked improvement in symptoms was observed. Conclusion: Hemostatic agents like Gelfoam which are often used during surgeries have the potential to cause compression of vital structures. Therefore, these should be removed once haemostatic control is accomplished and if it is to be retained, prompt post operatively monitoring is essential.

scholarly journals Spondylitis Presenting With Cauda Equina Syndrome in a 12 Year Old Boy

2020 ◽  
Vol 28 (1) ◽  
pp. 119-122
Author(s):  
Sukriti Das ◽  
Musannah Ashfaq ◽  
Kaniz Fatema Ishrat Jahan ◽  
Shamsul Islam Khan ◽  
Rakibul Islam ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Muscle Power ◽  
Cauda Equina ◽  
Surgical Excision ◽  
Lower Limbs ◽  
High Dose ◽  
Medical College ◽  
Bladder Control ◽  
History Of ◽  
Antibiotic Regime

A 12-year-old boy presented with a 2-week history of low back pain and 10-day history of weakness of the lower limbs,5-day history of inability to pass urine. An MRI scan of the lumbar spine showed dehiscent lamina of L5,S1 and an epidural abscess. He was admitted to hospital and treated with a high dose of IV antibiotics followed by radical surgical excision of the lesion. Histopathology showed features of abscess. He eventually recovered bowel and bladder control and regained muscle power in the lower limbs. Infection is not a common cause of cauda equina syndrome. Aggressive surgical treatment combined with a prolonged antibiotic regime is recommended to achieve a satisfactory result. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 119-122

scholarly journals Development of a toolkit for early identification of cauda equina syndrome

2016 ◽  
Vol 17 (06) ◽  
pp. 559-567 ◽  
Author(s):  
Sue Greenhalgh ◽  
Carole Truman ◽  
Valerie Webster ◽  
James Selfe
Keyword(s):  
At Risk ◽  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Lower Limbs ◽  
Motor Deficit ◽  
Medical Setting ◽  
Low Back ◽  
Content Validation

AimTo develop a simple cauda equina syndrome (CES) toolkit to facilitate the subjective examination of low back pain patients potentially at risk of CES. To undertake preliminary validation of the content of the toolkit.BackgroundCES is a rare condition which can be very challenging to identify in a generalist medical setting.MethodA three phase iterative design with two stake holder groups; extended scope practitioners experienced in managing CES patients and CES sufferers.Toolkit developmentSynthesis of existing CES literature with CES patient data generated from in depth interviews.Toolkit validationContent validation of the draft toolkit with CES patients.Toolkit validationContent validation of the draft toolkit with extended scope physiotherapists.FindingsA three arm toolkit has been developed for use with patients considered by the clinician as at risk of developing CES (eg, worsening low back pain with symptoms/signs of progressive sensory-motor deficit in the lower limbs); patient expertise, clinical expertise, research and pathways. Uniquely, the toolkit drew upon the lived experiences of patients suffering from CES to inform the content.

scholarly journals Applying Qualitative Methods in Organizations: A Note for Industrial/Organizational Psychologists

2015 ◽  
Author(s):  
Benjamin Ehigie ◽  
Rebecca Ehigie
Keyword(s):  
Social Sciences ◽  
Qualitative Methods ◽  
Delphi Method ◽  
Empirical Studies ◽  
Group Discussion ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Organizational Studies ◽  
The Social ◽  
Technique Delphi

Early approach to research in industrial and organizational (I/O) psychology was oriented towards quantitative techniques as a result of influences from the social sciences. As the focus of I/O psychology expands from psychological test development to other personnel functions, there has been an inclusion of qualitative methods in I/O psychology practice. The present paper therefore examines how qualitative methods like observation, interviews, ethnography, focus group discussion, nominal group technique, Delphi method, and projective techniques can be used by I/O psychologists in organizational studies. It is believed that knowledge gained on the application s of these qualitative methods would enhance understanding of workers’ behaviors in organizations and facilitate management decisions. Empirical studies are also presented, on how these qualitative methods have successfully been used in organization.

scholarly journals Pregnancy in a diagnosed case of cauda equina syndrome and it’s management: a case report

2021 ◽  
Vol 10 (7) ◽  
pp. 2917
Author(s):  
Yashaswi Pandey ◽  
Kalyani Saidhandhapani
Keyword(s):  
Case Report ◽  
Cauda Equina Syndrome ◽  
Residual Disease ◽  
Burst Fracture ◽  
Cauda Equina ◽  
Lumbar Vertebrae ◽  
Lower Limbs ◽  
Autonomic Dysreflexia ◽  
Foot Drop ◽  
Cord Injury

As with many rare conditions, little is known about cauda equina syndrome (CES) and reproduction. Knowledge pertaining to complications during pregnancy and its management in a patient with diagnosed case of CES is even more scant. The information which we have is from attending on individual cases who presented with CES diagnosed during pregnancy. The following case report demonstrates pregnancy in a known case of CES, diagnosed after sustaining a burst fracture of lumbar vertebrae followed by surgical decompression at puberty. Patient conceived spontaneously with residual disease as symptoms of perineal numbness, sensory deficit in both lower limbs and persistent saddle hypoesthesia along with foot drop and gait abnormalities and presented at 30 weeks of gestation. CES is an unusual entity that appears in between 2-6% of all cases of disc herniation in the lumbar segment. Related post-traumatic presentations are extremely rare. Pregnancy exacerbates most problems associated with spinal cord injury. Autonomic dysreflexia may present as a complication in a case of pregnancy with CES which may be life threatening and requires immediate treatment. Antenatal management and complications of pregnancy in a diagnosed case of CES has not been documented till date.

scholarly journals Barriers to implementing motivational interviewing in addiction treatment: A nominal group technique process evaluation

2021 ◽  
Vol 2 ◽  
pp. 263348952110184
Author(s):  
Melissa R Hatch ◽  
Kristine Carandang ◽  
Joanna C Moullin ◽  
Mark G Ehrhart ◽  
Gregory A Aarons
Keyword(s):  
Motivational Interviewing ◽  
Process Evaluation ◽  
Nominal Group Technique ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Nominal Group ◽  
Management Level ◽  
Implementation Program ◽  
Ebp Implementation ◽  
Staff Level

Background: The successful implementation of evidence-based practices (EBPs) in real-world settings requires an adaptive approach and ongoing process evaluation and tailoring. Although conducting a needs assessment during the preparation phase of implementation is beneficial, it is challenging to predict all barriers to EBP implementation that may arise over the course of implementation and sustainment. This article describes a process evaluation that identified emergent and persistent barriers that impacted the implementation of an EBP across multiple behavioral health organizations and clinics. Methods: This study was conducted during the first cohort of a cluster randomized controlled trial testing the effectiveness of the Leadership and Organizational Change for Implementation (LOCI) strategy to implement motivational interviewing (MI) in substance use disorder treatment agencies and clinics. We used a modified nominal group technique (NGT) in which clinic leaders identified barriers faced during the implementation process. Barriers were categorized, then ranked and rated according to leaders’ perceptions of each barrier’s influence on implementation. The barriers were then contextualized through individual qualitative interviews. Results: Fifteen barriers were identified, grouped into staff-level barriers, management-level barriers, and implementation program barriers. Time and resistance to MI were rated as the most influential staff-level barriers. Among management-level barriers, time was also rated highest, followed by turnover and external contractual constraints. The most influential implementation barrier was client apprehension of recording for fidelity assessment and feedback. Individual interviews supported these findings and provided suggested adaptations for future implementation efforts. Conclusion: EBP implementation is an ongoing process whereby implementation strategies must be proactively and strategically tailored to address emergent barriers. This research described a process evaluation that was used to identify 15 emergent and/or persistent barriers related to staff, management, and the implementation program. Using implementation strategies that can be tailored and/or adapted to such emergent barriers is critical to implementation effectiveness. Plain Language Summary Unforeseen barriers often arise during the course of implementation. Conducting evaluations during implementation allows for tailoring the implementation strategy. As part of a larger study using the Leadership and Organizational Change for Implementation (LOCI) strategy to implement motivational interviewing (MI), we collected data from the first cohort of LOCI clinic leaders to identify barriers to MI implementation that persisted despite advanced planning and to understand unanticipated barriers that arose during implementation. Leaders identified 15 barriers faced during the implementation process that fell into three categories: staff-level barriers, management-level barriers, and implementation program barriers. The leaders ranked time as the most influential barrier at both the staff and management levels. Staff apprehension, resistance to MI implementation, and staff turnover were also of significant concern to leaders. Future implementation efforts may benefit from conducting a similar process evaluation during the implementation phase.

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