Compressive Pressure Versus Time in Cauda Equina Syndrome

Abstract

Two-stage screening:1) Abstract screen: animal models of cauda equina compression for a maximum 1 week duration 2) Full-text screen: constant, single-level, paracentral pressure defined in mmHg.Decompression: studies of compression followed by decompression that met the same criteria were also included.Exclusion: studies using percentage or size of compression rather than pressure, and those using multi-level compression or circumferential compression.Controls: we used either pre-compression values or those from concurrent sham operated animals, for decompression studies we used pre-decompression values.

New-Onset Paralysis following Biopsy of a Retroperitoneal Mass with Intraspinal Extension in a Pediatric Patient

“…18 This mass effect on vasculature is further exacerbated when the compressive force on the spinal arteries exceeds the MAPs required to perfuse the spinal cord. 13 In this patient, arterial hypotension was likely a major contributor to the ischemia as the patient's arterial pressures were unable to overcome the compressive force of the mass. Decreased spinal perfusion pressures have been known to contribute to ischemia even without compression, especially in "watershed" regions of the spinal cord that do not have a rich blood supply.…”

“…In cases of compressive ischemia, the duration of compression is thought to directly relate to the severity of ischemia. 13 While not particularly common, paralysis as a complication of prone positioning during spinal surgeries has been well documented. [14][15][16][17] The development of spinal cord ischemia in the prone position is multifactorial and may be impacted by hemodynamic changes associated with the positioning itself as well as the effects of anesthesia on lowering arterial perfusion to the spinal cord.…”

“…[14][15][16][17] The development of spinal cord ischemia in the prone position is multifactorial and may be impacted by hemodynamic changes associated with the positioning itself as well as the effects of anesthesia on lowering arterial perfusion to the spinal cord. 13,14,17 These changes become significantly more pertinent in this case where prone positioning also introduces a compressive stress on the spinal vasculature. In the prone position, the mass can be seen compressing the spinal cord and the anterior spinal artery (►Fig.…”

Racial and Health Insurance Differences in Patient Outcomes after Surgical Treatment for Cauda Equina syndrome

“…3 Timely evaluation, diagnosis, and advanced imaging, typically with magnetic resonance imaging, and urgent operative intervention are recommended within 24 to 48 hours at the latest to prevent permanent neurological deficits. [4][5][6] For physicians, CES has been associated with significant medico-legal and financial consequences, with reports of damages paid in approximately half of all CES cases. 7 Racial disparities in the care of patients and outcomes following health system utilization have been well documented.…”

“…CES is caused by compression of the lumbar nerve roots, and clinical presentations may include a combination of bladder, bowel, and sexual dysfunction, saddle anesthesia, back and leg pain, and lower limb weakness 3 . Timely evaluation, diagnosis, and advanced imaging, typically with magnetic resonance imaging, and urgent operative intervention are recommended within 24 to 48 hours at the latest to prevent permanent neurological deficits 4–6 . For physicians, CES has been associated with significant medico-legal and financial consequences, with reports of damages paid in approximately half of all CES cases 7 …”