Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study

Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. This is a prospective m...

Full description

Saved in:
Bibliographic Details
Published in:The Lancet regional health. Europe 2023-01, Vol.24, p.100545-100545, Article 100545
Main Authors: Woodfield, Julie, Hoeritzauer, Ingrid, Jung, Josephine, Watts, Anna, Moon, Richard D.C., Darwish, Stacey, Roy, Holly, Copley, Phillip C., Poon, Michael T.C., Grahovac, Gordan, Statham, Patrick F.X., Abulaila, Motaz MS, Ajmi, Qasim, Al-Mahfoudh, Rafid, Ali, Chadi, Amarouche, Meriem, Arora, Mohit, Arora, Mukul, Awan, Mariam, Bateman, Antony, Bennett, Iwan, Bhatti, Imran, Bonanos, George, Borg, Anouk, Bourne, James, Brennan, Rachael, Brown, Jennifer, Burton, Oliver, Busby, Christopher, Chiverton, Neil, Clark, Simon, Davies, Benjamin, Demetriades, Andreas K, Duncan, James, Durnford, Andrew, Dyson, Edward W, Eames, Niall, Edlmann, Ellie, Elson, Becca, Fadelalla, Mohammed, Fountain, Daniel M, Gardner, Adrian, Ghosh, Arnab, Gill, James R, Glasmacher, Stella A, Grenfell, Rebecca, Haliasos, Nikolaos, Hammett, Tim, Hannan, Cathal John, Hill, Ciaran Scott, Hossain-Ibrahim, Kismet, Hughes, Laura, Hussain, Muhammad, Hussain, Shakir, Jamjoom, Aimun AB, John, Bethan, Khan, Muhammad, Klejnotowska, Adriana, LaCava, Roberta, Lammy, Simon, Lea, Matthew, Leung, Andraay HC, Liew, Ignatius, Luo, Weisang, Manfield, James, Mannion, Richard, Merola, Joseph, Mohmoud, Khalid Abubaker, Moon, Richard, Morrison, Rory, Murray, Odhran, Nnandi, Colin, Pandit, Anand, Patel, Nitin, Poon, Michael TC, Prasad, Kuskoor Seethram Manjunath, Pronin, Savva, Pujara, Shyam, Purushothaman, Balaji, Rajwani, Kapil, Sadek, Ahmed-Ramadan, Schramm, Moritz, Sell, Philip J, Sharma, Himanshu, Sheikh, Asim, Sofela, Agbolahan, Spink, George, Srikandarajah, Nisaharan, Statham, Patrick FX, Stokes, Stuart, Strachan, Euan, Thanabalasundaram, Gopiga, Ulbricht, Christian, White, David, Zolnourian, Ardalan
Format: Article
Language:English
Subjects:
Back pain
Cauda equina syndrome
Cohort study
Spinal surgery
Urinary retention
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.
ISSN:2666-7762
2666-7762
DOI:10.1016/j.lanepe.2022.100545