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Curtis Lopez C, Berg AJ, Clayton B, Siddique I, Carrasco R, Horner D, Angus M. Evaluation of the role of anal tone and perianal sensation examination in the assessment of suspected cauda equina syndrome. Br J Neurosurg 2024; 38:923-927. [PMID: 34796788 DOI: 10.1080/02688697.2021.2005775] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/25/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Cauda equina syndrome (CES) can present with a varied constellation of clinical signs and symptoms, which together with the time-sensitive nature of the condition and risk of catastrophic clinical outcome, presents a significant challenge to those assessing patients with this suspected diagnosis. Anal tone is commonly tested during initial assessment using a digital rectal examination (DRE). This study aims to evaluate the diagnostic value of anal tone and perianal sensation assessment in patients with suspected CES and report modern prevalence data on CES within a neurosciences centre. MATERIALS AND METHODS Consecutive patients with suspected CES presenting over three years to the Emergency Department (ED) of a busy tertiary centre were included in the study. History and examination findings, documented in the ED notes, were assessed and these variables were correlated with the presence or absence of cauda equina compression on subsequent magnetic resonance imaging (MRI). RESULTS Out of 1005 patients with suspected CES, 117 (11.6%) had MRI confirmed cauda equina compression (MRI + ve CES). 35% of MRI + ve patients and 31% of MRI -ve patients had reduced anal tone. Using univariate and multivariable logistic regression analyses, no associations were found between abnormal anal tone and MRI + ve CES for patients of all ages. The univariate logistic regression analysis identified altered perianal sensation to be significantly associated with MRI + ve CES in patients ≤42 years old. This association was no longer present when an adjusted multivariable logistic regression was performed. CONCLUSION The prevalence of MRI + ve CES was 11.6%. Our findings suggest that the clinical finding of reduced anal tone has no demonstrable diagnostic value for those with suspected CES, either in itself or in combination with other clinical findings. Further studies are needed to confirm the diagnostic efficacy of assessing perianal sensation in this context.
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Affiliation(s)
- Carlos Curtis Lopez
- University of Manchester, Manchester, England
- Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Bethan Clayton
- University of Manchester, Manchester, England
- Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Roberto Carrasco
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Daniel Horner
- Division of Population Health, Health Services Research & Primary Care, School of Biological Sciences, The University of Manchester, Manchester, UK
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Moradi Z, Shahali S, Ahmadi F, Montazeri A. Correlates of sexual function in women with acute lumbar disc herniation in Iran: a cross-sectional study. Sci Rep 2024; 14:6430. [PMID: 38499726 PMCID: PMC10948880 DOI: 10.1038/s41598-024-57274-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/15/2024] [Indexed: 03/20/2024] Open
Abstract
Evidence suggests that lumbar disc herniation (LDH) influences sexual function to a great deal. However, most existing studies have been conducted on men. Thus, the current study aimed to assess sexual function and its correlates in women with acute LDH. This descriptive cross-sectional study was conducted on 350 women of reproductive age with acute LDH in Fasa, Iran in 2023. The mean score of female sexual function was 21.33 (3.38). Almost 80% of women had sexual dysfunction. Women scored lower on sexual desire and the higher on lubrication. As the severity of LDH increased, arousal, lubrication and sexual pain score decreased and low back pain (LBP) score increased (p < 0.05). The number of sexual activities after disc herniation was significantly lower in the women with sexual dysfunction (p < 0.001). Regression analysis showed a significant association between sexual dysfunction and LBP intensity (OR = 1.13, CI 1.02-1.26, p = 0.01) and lumbar disc herniation intensity (OR = 2.22, CI 1.07-4.62, p = 0.03). Lumbar disc herniation (LDH) may significantly affect women's sexual function. Severity of low back pain and severity of lumbar disc herniation were found to be risk factors for sexual dysfunction in this population.
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Affiliation(s)
- Zahra Moradi
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares Univesity, Tehran, Iran
| | - Shadab Shahali
- Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares Univesity, Tehran, Iran.
| | - Fazlollah Ahmadi
- Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Montazeri
- Health Metrics Research Center, Institute for Health Sciences Research, ACECR, Tehran, Iran
- Faculty of Humanity Sciences, University of Science & Culture, Tehran, Iran
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Giroux D, Branconnier C, Bussières A, Théroux J, Blanchette MA. Frequency and indication of non-musculoskeletal examinations: a cross-sectional survey of Quebec chiropractors. Chiropr Man Therap 2024; 32:6. [PMID: 38419063 PMCID: PMC10903024 DOI: 10.1186/s12998-023-00522-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/07/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Approximately 1% of low back pain is estimated to be caused by serious systemic diseases, including cancer, infection, or abdominal aortic dissection. This study aimed to determine the frequency of execution of non-MSK physical examination procedures among Quebec chiropractors and to identify the clinical context that prompts them to use these physical examination procedures. METHODS Cross-sectional survey containing 44 questions administered to a random sample of Quebec chiropractors using a succession of online, postal and phone questionnaires. The 4-part survey questionnaire contained six demographic questions, 28 single-choice questions to determine the frequency of execution of non-MSK physical examination procedures, seven short clinical vignettes for which the respondents had to select the non-MSK examinations that would be required, and two questions inquiring about the proportion of new patients for which participants' felt non-MSK examinations were necessary and whether appropriate assessments were performed. The questionnaire was pilot tested, and feedback received integrated prior to administration. We conducted descriptive statistics, Pearson correlations, and an ANOVA. RESULTS The survey was completed by 182 chiropractors (response rate: 36.4%). The most commonly non-musculoskeletal examination performed daily were blood pressure (12.1%) and cranial nerves (4.9%). The most common tests never performed were oxygen saturation (68.7%), cardiac auscultation (69.2%), tibio-brachial index (71.4%), breast (86.8%), rectal (96.7%), testicular (95.6%), and vaginal (99.9%) exams. Female chiropractors and Quebec University in Trois-Rivières graduates reported that a significantly higher proportion of their new patients required a non-musculoskeletal physical examination compared to male participants (37.2% vs 28.3%) or Canadian Memorial Chiropractic College graduates (33.9% vs 19.9%). Reason for not performing a physical examination included the belief that another healthcare professional was better positioned to perform and/or interpret the related tests (76.4%). CONCLUSIONS Vital signs and cranial nerve examinations were the most frequency performed non-musculoskeletal examinations reported by chiropractors. Apart from the genitourinary exam almost never performed, most participants chose non-musculoskeletal examinations deemed appropriate for the patient's presentation.
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Affiliation(s)
- Danikel Giroux
- Departement de Chiropratique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada.
| | - Chloé Branconnier
- Departement de Chiropratique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada
| | - André Bussières
- Departement de Chiropratique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jean Théroux
- School of Allied Health, Chiropractic Discipline, Murdoch University, Perth, WA, Australia
| | - Marc-André Blanchette
- Departement de Chiropratique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, QC, Canada
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Woodfield J, Statham PFX, Hoeritzauer I. Letter to the Editor Regarding Publication Trends and Hot Spots in Cauda Equina Syndrome: A Bibliometric Analysis and Visualization of Current Research. World Neurosurg 2023; 178:289. [PMID: 37803677 DOI: 10.1016/j.wneu.2023.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK.
| | | | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK; Department of Clinical Neurosciences, NHS Lothian, Edinburgh, Scotland, UK
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Kimber D, Pigott T. Cauda equina screening in Physiotherapy: A qualitative study of physiotherapists in a community musculoskeletal service: Are we asking the right questions and are we asking the questions right? Musculoskelet Sci Pract 2023; 65:102773. [PMID: 37201228 DOI: 10.1016/j.msksp.2023.102773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/11/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
Cauda Equina Syndrome (CES) is a surgical emergency. With Physiotherapists increasingly taking on first-contact and spinal triage roles, screening for CES must be as thorough and effective as possible. This study explores whether Physiotherapists are asking the correct questions, in the correct way and investigates their experiences when screening for this serious condition. Thirty physiotherapists working in a community musculoskeletal service were purposively sampled and participated in semi-structured interviews. Data was transcribed and thematically analysed. All participants routinely asked bladder, bowel function and saddle anaesthesia screening questions although only 9 routinely asked about sexual function. Whether questions are asked in the correct way has never been studied. Sufficient depth of questioning, using lay terminology and explicit language was achieved by two-thirds of participants. Less than half of the participants framed the questions before asking them and only 5 participants combined all four dimensions. Whilst most clinicians felt comfortable asking general CES questions, half reported feeling uncomfortable when asking about sexual function. Issues around; gender, culture and language were also highlighted. Four main themes emerged from this study; i) Physiotherapists ask the right questions but frequently omit sexual function questions, ii) mostly, Physiotherapists ask CES questions in a way that patients understand however, there needs to be improvement in framing the context of the questions, iii) Physiotherapists generally feel comfortable with CES screening but there is some awkwardness surrounding discussion of sexual function and iv) Physiotherapists perceive there to be barriers to effective CES screening caused by culture and language.
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Affiliation(s)
- Damien Kimber
- MSK Service, Birmingham Community Healthcare NHS Trust, 1 Priestley Wharf, Holt Street, Aston, Birmingham, B7 4BN, UK.
| | - Tim Pigott
- Trauma & Orthopaedics, University of Salford School of Health & Society, The Crescent, Salford, M5 4WT, UK
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Zhang Y, Dai Z, Zhao T, Tian J, Xu J, Zhang J. Publication Trends and Hot Spots in Cauda Equina Syndrome: A Bibliometric Analysis and Visualization of Current Research. World Neurosurg 2023; 173:115-121. [PMID: 36754352 DOI: 10.1016/j.wneu.2023.01.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cauda Equina Syndrome (CES) is a relatively uncommon and complex disorder. Recently, there has been a surge in research on CES. Although the research directions are multifarious, the overall research trends are unclear at present. We aimed to identify the 100 most cited articles on CES and analyze the hot spots trends regarding CES related research by bibliometric analysis. METHODS Articles were obtained by conducting an English language search of the Web of Science Core Collection Databases with the keywords "cauda equina syndrome." The initial 390 articles returned from the search were analyzed by VOSviewer. Next, the top 100 most cited articles were further analyzed by title, authors, journal, year of publication, total citations, country of origin, institution, and keywords. RESULTS A total of 390 publications were identified. The top 100 most cited articles were listed in descending order of total citations (range: 196-11). These articles originated from 24 countries; among these countries, the United Kingdom contributed the most publications (n = 29). The most prolific journal was Spine (n = 27), and the University of Edinburgh was the most productive institution (n = 9). CONCLUSIONS The number of publications on CES increased steadily, with a stable rise in recent years. Some publications have been cited more than 100 times, indicating that these findings are widely accepted by relevant clinicians and contribute significantly to the knowledge of CES. This study represents the first bibliometric analysis and visualization of hot spots analysis and research trends on CES. We believe that this will aid clinical researchers in targeting future areas of research.
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Affiliation(s)
- Yaping Zhang
- General Office of the Administration, Zhejiang Provincial People's Hospital, Hangzhou, China; Department of Spine Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College People's Hospital, Hangzhou, Zhejiang, China
| | - Zhanqiu Dai
- Department of Spine Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College People's Hospital, Hangzhou, Zhejiang, China; Department of Orthopaedics, The Second Affiliated Hospital of Bengbu Medical College, Anhui, China; Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tingxiao Zhao
- Department of Spine Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College People's Hospital, Hangzhou, Zhejiang, China
| | - Jinlong Tian
- Department of Spine Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College People's Hospital, Hangzhou, Zhejiang, China; Department of Orthopaedics, The Second Affiliated Hospital of Bengbu Medical College, Anhui, China
| | - Jiongnan Xu
- Department of Spine Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College People's Hospital, Hangzhou, Zhejiang, China; The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jun Zhang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China; Department of Orthopedics, Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, Guizhou, China.
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Hazelwood JE, Hoeritzauer I, Carson A, Stone J, Demetriades AK. Long-term mental wellbeing and functioning after surgery for cauda equina syndrome. PLoS One 2021; 16:e0255530. [PMID: 34358259 PMCID: PMC8345886 DOI: 10.1371/journal.pone.0255530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/17/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Cauda Equina Syndrome (CES) can cause persisting life-changing dysfunction. There is scarce literature regarding the long-term assessment of CES symptoms, and rarer still is the impact of these symptoms on mental wellbeing investigated. This study assessed the long-term patient reported mental wellbeing outcomes of post-operative CES patients. Methods Patients who underwent surgery for CES between August 2013 and November 2014 were identified using an ethically approved database. They then completed validated questionnaires over the telephone assessing their mental and physical functioning (Short-Form 12 Questionnaire), generating the Physical Component Summary (PCS) and Mental Component Summary (MCS). Bladder, bowel and sexual function were also assessed using validated questionnaires. MCS scores were compared to both the Scottish mean and previously published cut-offs indicating patients at risk of depression. Correlations of MCS with bladder, bowel, sexual and physical dysfunction were examined and multifactorial regression to predict MCS from these variables analysed. Independent t-tests assessed the mean difference in MCS between patients presenting with incomplete CES (CES-I) and CES with retention (CES-R) and between those with radiologically confirmed and impending CES. Results Forty-six participants with a mean follow-up time of 43 months completed the study. The mean (±SD) MCS was 49 (±11.8) with 22% demonstrating poor mental health related quality of life in comparison to the Scottish mean. Overall, 37% had scores consistent with being at risk for depression with in the last 30 days, and 45% within the last 12 months. MCS was significantly correlated with Urinary Symptoms Profile (USP) score (-0.608), NBDS score (-0.556), ASEX score (-0.349) and PCS score (0.413) with worse bladder, bowel, sexual and physical dysfunction associated with worse MCS score. Multifactorial regression analysis demonstrated both urinary (USP score p = 0.031) and bowel function (NBDS score p = 0.009) to be significant predictive variables of mental health related quality of life. There were no significant mean differences in MCS between those presenting with CES-I and CES-R or those with radiologically complete and impending CES. Discussion This study demonstrates a high frequency of being at risk for depression in patients with CES and identifies outcome measures (physical, sexual and more so bladder and bowel dysfunction) associated with poorer mental wellbeing. Our large cohort and long follow-up highlight that CES patients should be considered at risk of depression, and the need to consider mental health outcomes following CES surgery.
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Affiliation(s)
- James E. Hazelwood
- Edinburgh Spinal Surgery Outcomes Study Group, Edinburgh, United Kingdom
- Chelsea and Westminster Hospital, London, United Kingdom
| | - Ingrid Hoeritzauer
- Edinburgh Spinal Surgery Outcomes Study Group, Edinburgh, United Kingdom
- Department of Clinical Neurosciences (Neurology), Royal Infirmary of Edinburgh, Little France, Edinburgh, Scotland, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Alan Carson
- Department of Clinical Neurosciences (Neurology), Royal Infirmary of Edinburgh, Little France, Edinburgh, Scotland, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Department of Rehabilitation Medicine, NHS Lothian, Edinburgh, United Kingdom
| | - Jon Stone
- Department of Clinical Neurosciences (Neurology), Royal Infirmary of Edinburgh, Little France, Edinburgh, Scotland, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Andreas K. Demetriades
- Edinburgh Spinal Surgery Outcomes Study Group, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Department of Clinical Neurosciences (Neurosurgery), Royal Infirmary of Edinburgh, Little France, Edinburgh, Scotland, United Kingdom
- * E-mail:
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Butenschoen VM, Abulhala S, Meyer B, Gempt J. Body mass index has an impact on preoperative symptoms but not clinical outcome in acute cauda equina syndrome. Sci Rep 2021; 11:13918. [PMID: 34230508 PMCID: PMC8260780 DOI: 10.1038/s41598-021-92969-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/17/2021] [Indexed: 11/09/2022] Open
Abstract
Cauda equina syndrome (CES) presents a surgical emergency with treatment required within 48 h. Symptoms include reduced saddle sensation, micturition difficulties, and/or anal sphincter impairment. Controversy exists regarding the effect on and coincidence of overweight with CES. We performed a retrospective case-control study of all patients treated surgically for acute complete and incomplete CES in our neurosurgical department from 2009 to 2020, focusing on the preoperative BMI and postoperative neurological outcome. In addition, we performed a comprehensive literature review. Fifty patients with CES were included, of whom 96% suffered from a decompensated lumbar spinal stenosis or disc prolapse between the L4/5 and L5/S1 levels. Our cohort population was overweight but not obese: mean BMI was 27.5 kg/m2, compared with 27.6 kg/m2 in patients with degenerative spine surgery. BMI did not significantly influence the postoperative outcome, but it did affect preoperative symptoms and surgery duration. Symptom duration significantly differed depending on the underlying cause for CES. The literature review revealed sparse evidence, with only four clinical case series presenting contradictory results. We provide a comprehensive literature review on the current evidence regarding CES and obesity and conclude that we did not observe an association between obesity and CES occurrence. Patients with CES and other degenerative spinal pathologies belong to an overweight but not obese population. Body Mass Index has an impact on preoperative symptoms but not clinical outcome in acute CES.
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Affiliation(s)
- Vicki M Butenschoen
- Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Shadi Abulhala
- Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany
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Katzouraki G, Zubairi AJ, Hershkovich O, Grevitt MP. A prospective study of the role of bladder scanning and post-void residual volume measurement in improving diagnostic accuracy of cauda equina syndrome. Bone Joint J 2020; 102-B:677-682. [PMID: 32475252 DOI: 10.1302/0301-620x.102b6.bjj-2020-0195.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Galateia Katzouraki
- Nottingham University Hospitals NHS Trust Ringgold standard institution, Spinal Unit, Nottingham, UK
| | | | - Oded Hershkovich
- Nottingham University Hospitals NHS Trust Ringgold standard institution, Spinal Unit, Nottingham, UK
| | - Michael P Grevitt
- Nottingham University Hospitals NHS Trust Ringgold standard institution, Spinal Unit, Nottingham, UK
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An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome. Acta Neurochir (Wien) 2019; 161:1887-1894. [PMID: 31263950 PMCID: PMC6704093 DOI: 10.1007/s00701-019-03973-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 05/30/2019] [Indexed: 01/19/2023]
Abstract
Background Data regarding long-term outcomes following surgery for cauda equina syndrome (CES) is scarce. In addition, these studies rely on patient descriptions of the presence or absence of symptoms, with no gradation of severity. This study aimed to assess long-term bladder, bowel, sexual and physical function using validated questionnaires in a CES cohort. Methods A pre-existing ethically approved database was used to identify patients who had undergone surgery for CES between August 2013 and November 2014. Patients were contacted over a 1-month period between August and September 2017 and completed validated questionnaires via telephone, assessing bladder (Urinary Symptom Profile), bowel (Neurogenic Bowel Dysfunction Score), sexual dysfunction (Arizona Sexual Experiences Scale) and physical function (Physical Component Summary of SF-12 Questionnaire), with scores compared between those presenting with incomplete CES (CES-I) and CES with retention (CES-R). Patients were also asked which of their symptoms currently they would most value treatment for and what healthcare services they had accessed post-operatively. Results Forty-six of 77 patients (response rate 72%, inclusion rate 60%) with a mean age of 45 years (21–83) and mean time since admission of 43 months (range 36–60) took part in the follow-up study. The prevalence of bladder dysfunction was 76%, bowel dysfunction 13%, sexual dysfunction 39% and physical dysfunction 48%. Patients presenting with CES-R had significantly worse long-term outcomes in bladder (stream domain), bowel and sexual function in compared to those with CES-I. Pain was chosen as the symptom patients would most value treatment for by 57%, but only 7% reported post-operative pain management referral. Conclusions With a mean follow-up time of 43 months, these findings confirm the high prevalence of long-term bladder, sexual and physical dysfunction in CES patients and that a diagnosis of CES-R confers poorer outcomes. This study provides useful, objective data to guide the expectations of patients and clinicians.
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Evaluation and management of cauda equina syndrome in the emergency department. Am J Emerg Med 2019; 38:143-148. [PMID: 31471075 DOI: 10.1016/j.ajem.2019.158402] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cauda equina syndrome (CES) may be a devastating disease with the potential for significant patient morbidity. It is essential for emergency clinicians to be aware of how to effectively diagnose and manage this condition. OBJECTIVE This article provides a narrative review of the diagnosis and management of CES for the emergency clinician. DISCUSSION Cauda equina syndrome is a rare but emergent condition associated with back pain. It can result in severe morbidity and can be due to a variety of causes, most commonly vertebral disc protrusion. Diagnosis is often delayed, which may result in a poor prognosis. Red flags and findings consistent with CES include bilateral neurogenic sciatica, reduced perineal sensation, altered bladder function leading to painless urinary retention, loss of anal tone, and loss of sexual function. In isolation, history and examination findings demonstrate poor sensitivity. Symptoms may occur either suddenly or gradually, and most patients do not present with all of these symptoms. Postvoid bladder volume assessments can assist in the evaluation, but the diagnosis typically involves magnetic resonance imaging (MRI) or computed tomography myelography if MRI is not available. Treatment relies upon surgical consultation and operative intervention for decompression. CONCLUSION Cauda equina syndrome can be a difficult diagnosis. However, knowledge of the history and examination findings, imaging, and treatment can assist the emergency clinician in optimizing management of this condition.
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