Does rectal examination have any value in the clinical diagnosis of cauda equina syndrome?

Gooding, Benjamin W. T.; Higgins, Mark; Calthorpe, D.

doi:10.3109/02688697.2012.732715

Cited by 46 publications

(34 citation statements)

References 21 publications

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“…This study displays unique data on the presenting symptoms of a large group of CES patients, proving that, next to the well-acknowledged micturition dysfunction, also defecation and sexual dysfunction are common at presentation. Anal sphincter tension and anal sphincter reflex are often tested in CES patients, even though several studies found no diagnostic value for these tests [18][19][20][21]. In the current study, abnormal anal sphincter reflex was not significantly associated with any of the diagnostic criteria for CES used in this study (closest to an association was defecation dysfunction with p = 0.096).…”

Section: Discussioncontrasting

confidence: 60%

Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

et al. 2017

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Background Even though micturition, defecation, and sexual function are substantially affected in cauda equina syndrome (CES), data on outcome are scarce. Methods Medical files of patients operated on lumbar herniated disc were screened for CES and retrospectively analyzed for baseline characteristics, outcome of micturition, defecation, and sexual function and possible predictors. Results Seventy-five CES patients (52% men) were included with a mean age of 44 years. L5-S1 was the most common affected level. Duration of CES complaints at presentation was, on average, 84 h (median 48 h). Prevalence of symptoms at presentation: sciatica (97%), altered sensation of the saddle area (93%), micturition dysfunction (92%), and defecation dysfunction (74%). Only 26 patients were asked about sexual dysfunction of whom 25 patients experienced dysfunction. Female gender was associated with more defecation dysfunction at presentation than male gender (OR 4.11; p = 0.039). All patients underwent decompressive surgery. Two post-operative follow-up (FU) moments took place after a mean of 75 h and 63 days.Outcomes at second FU moment: micturition dysfunction 48%, defecation dysfunction 42%, sexual dysfunction 53%, sciatica 48%, and altered sensation of the saddle area 57%. A shorter time to decompression was associated with more sciatica at FU 1 (p = 0.042) which effect had disappeared at FU 2. Conclusion This study is unique in (1) displaying the presenting features in a large cohort of CES patients, (2) demonstrating that recovery after decompression is slow and far from complete in the majority of patients with regard to micturition, defecation, and sexual function and (3) evaluating predictors for outcome.

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Section: Discussioncontrasting

confidence: 60%

Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

et al. 2017

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“…Back pain and radicular leg pain are the most common presentations of CES, although the classic teaching is that of perineal paresthesias and bowel and bladder changes [20,21]. However, these are commonly found in the later stages of CES.…”

Section: Discussionmentioning

confidence: 99%

Outcomes Following Surgical Management of Cauda Equina Syndrome: Does Race Matter?

Jain

Menga

Mesfin

2017

J. Racial and Ethnic Health Disparities

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Cauda equina syndrome (CES) is a surgical emergency requiring urgent spinal decompression. Our objective is to analyze the association between race and in-hospital outcomes (complications, mortality, length of stay, and discharge disposition) in patients with CES. This is a retrospective cohort study of CES patients identified via the Nationwide Inpatient Sample (NIS) from 2000 to 2010 in inpatient hospitalizations in the USA. The patient sample includes 46,017 patients ≥18 undergoing spine surgery for CES. Using ICD9-CM codes, patient records with a diagnosis of CES from 2003 to 2010 were selected from the NIS database and sorted by mortality, complications, length of hospital stay, and discharge status. Demographic information (age, gender, race, and insurance status) and hospital characteristics were evaluated. African-American patients were 1.38-fold (p < 0.02; 95% odds ratio [OR] 1.05-1.83) more likely than Caucasian patients to develop complications based on a multivariate logistic regression model adjusted for patient age, insurance status, surgical approach, and hospital size. There was no difference in mortality among patients of various races in both univariate and multivariate analysis. A multivariate linear regression model adjusted for insurance status, surgical approach, and hospital size revealed that, compared to Caucasian patients, length of hospitalization in African-American patients was 1.92 days longer (p < 0.01), 1.34 days longer (p < 0.01) in Hispanic patients, and 2.24 days longer (p < 0.01) in Asian-American patients. African-American patients were 0.59-fold (p < 0.01; 95% OR 0.494-0.708) less likely than Caucasian patients to have routine discharge to home. African-American patients hospitalized for surgical management of CES experience significantly more complications, longer length of hospitalizations, and higher discharge to non-home locations, compared to Caucasian patients.

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“…Most patients with CES due to LDH have a history of LDH, and the percentage was reported as 70%-82% (4, 5, 8). Gooding et al (6) suggested that CES can be seen in only 0.12% of patients with LDH. Additionally, it was reported that 1%-2% cases of LDH may cause CES (7).…”

Section: Discussionmentioning

confidence: 99%

A Young Patient with Acute Cauda Equina Syndrome Due to Traumatic Disc Herniation

Başol¹,

Deniz²,

Gökçe³

et al. 2015

JAEMCR

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Does rectal examination have any value in the clinical diagnosis of cauda equina syndrome?

Cited by 46 publications

References 21 publications

Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

Outcomes Following Surgical Management of Cauda Equina Syndrome: Does Race Matter?

A Young Patient with Acute Cauda Equina Syndrome Due to Traumatic Disc Herniation

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