Predictors of outcome in cauda equina syndrome

Kennedy, John G.; Soffe, Karen; McGrath, Angela; Stephens, Michael M.; Walsh, M. G.; McManus, F.

doi:10.1007/s005860050180

Cited by 100 publications

(100 citation statements)

References 21 publications

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“…The common concept is to consider the first 48 hours as the critical interval. [21][22][23][24][25] However, there are other studies concluding that decompression before or after 48 hours does not influence the neurologic outcome. [26] In a series of 50 patients with CES diagnosed after an average of 12 days, neurologic recovery was evident in all patients who were surgically decompressed.…”

Section: Discussionmentioning

confidence: 99%

Transverse sacral fractures and concomitant late-diagnosed cauda equina syndrome

Bekmez¹,

Demirkıran²,

Çağlar³

et al. 2014

Ulus Travma Acil Cerrahi Derg

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Transverse sacral fractures in young patients occur with high-energy mechanisms. Because of the drawbacks in radiographic and neurologic evaluations of the sacral area in polytrauma patients, misdiagnosis is quite common. In this study, we aimed to report our clinical results in three patients with displaced transverse sacral fractures compromising the sacral canal and concomitant late-diagnosed (at least 48 hours) cauda equina syndrome. Bilateral lumbopelvic fixation, followed by sacral laminectomy and decompression, was performed in all patients. Despite the late-diagnosed cauda equina syndrome, we observed that surgical decompression and lumbopelvic fixation had positive effects on neurologic recovery, pain relief and early unsupported mobilization.

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Section: Discussionmentioning

confidence: 99%

Transverse sacral fractures and concomitant late-diagnosed cauda equina syndrome

Bekmez¹,

Demirkıran²,

Çağlar³

et al. 2014

Ulus Travma Acil Cerrahi Derg

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“…Many of our patients with sphincter disturbance will have had hesitancy rather than full painless retention with overflow and, as such, will again probably have a better outcome according to previous arguments. 5,6 Some recent studies and meta-analyses have suggested that early decompressive surgery is likely to be of benefit in CES. 1,2 This debate will probably never be fully resolved.…”

Section: Discussionmentioning

confidence: 99%

“…The concept of partial CES has previously been proposed as a predictor of better outcome after surgery than complete CES. 5,6 The issues that can be agreed on are that the most common cause of CES is a prolapsed intervertebral disc and that CES is a cause of serious disability, which may result in high-cost litigation in cases of possible mismanagement. 7,8 Although CES is a clinical diagnosis, patients require magnetic resonance imaging (MRI) prior to surgery to assess the aetiology and level of pathology in the spinal canal.…”

mentioning

confidence: 99%

The Value of Interhospital Transfer and Emergency MRI for Suspected Cauda Equina Syndrome: A 2-Year Retrospective Study

Crocker

Fraser

Boyd

et al. 2008

annals

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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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“…Cauda equina is rarely reported to be involved by tuberculosis and this is the second case report in the world literature of this sort [6]. Cauda equina is a surgical emergency, and early drainage is important for early recovery of bladder/bowel control [7,8]. In fact, Kennedy et al [7] studied several factors responsible for a successful outcome in cauda equina, and were of opinion that early diagnosis and early decompression are the most important predictors of a successful outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Cauda equina is a surgical emergency, and early drainage is important for early recovery of bladder/bowel control [7,8]. In fact, Kennedy et al [7] studied several factors responsible for a successful outcome in cauda equina, and were of opinion that early diagnosis and early decompression are the most important predictors of a successful outcome. Kapoor et al [6] reported one such case of cauda equina being caused by tuberculous involvement of posterior elements, and reported improvement in neurological status by laminectomy.…”

Section: Discussionmentioning

confidence: 99%

Easy drainage of presacral abscess

Nigam

Chhabra

2006

Eur Spine J

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Presacral region is one of the difficult regions for drainage of abscess as the approaches described for this carry a lot of morbidities. Transpedicular approach is described for the drainage of presacral abscess. Further, tuberculous abscess as a cause of cauda equina syndrome is reported. Patient had complete neurological recovery within weeks of drainage of abscess. Transpedicular drainage of presacral abscess is a safer option for recently developed neurological deficit. Late presentation may need anterior approach, which is associated with increased morbidity.

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Predictors of outcome in cauda equina syndrome

Cited by 100 publications

References 21 publications

Transverse sacral fractures and concomitant late-diagnosed cauda equina syndrome

Transverse sacral fractures and concomitant late-diagnosed cauda equina syndrome

The Value of Interhospital Transfer and Emergency MRI for Suspected Cauda Equina Syndrome: A 2-Year Retrospective Study

Easy drainage of presacral abscess

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