An algorithm for suspected cauda equina syndrome

• Published in: Annals of the Royal College of Surgeons of England Vol. 91; no. 4; pp. 358 - 359
• Main Author: Todd, N V
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.05.2009; The Royal College of Surgeons of England
• Subjects: Algorithms; Bladder; Cauda Equina Syndrome; Diskectomy - methods; Hospitals; Humans; Letters and Comments; Lumbar Vertebrae - surgery; Neurological disorders; NMR; Nuclear magnetic resonance; Pain; Patients; Polyradiculopathy - diagnosis; Surgery; Surgical outcomes; United Kingdom > UK
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/003588409X428487

There are a group of patients at risk of developing a cauda equina syndrome where there are ‘red flags’ including bilateral radicular pain and/or bilateral sensory disturbance, bilateral motor weakness and/or bilateral loss of reflexes. Patients have an incomplete cauda equina syndrome (CESI) if they have subjective and/or objective evidence of neurological losses such as impaired bladder sensation, impaired urethral sensation, impaired rectal sensation and/or objective genital/peri-anal (S3-S5) sensory disturbance and/or reduction in anal tone, provided the bladder is still functioning normally. 5. [...]the fact that there is uncertainty in this area and the fact that some studies have suggested a window of opportunity extending to 24 h (or possibly 48 h) after the onset of CESR, suggests that perhaps the precautionary principle should be adopted and patients should be decompressed urgently on the basis that there is scientific uncertainty.