Ambulatory Outcomes of Traumatic Cauda Equina Syndrome and Conus Medullaris Syndrome: A Systematic Review

Abstract

Background: The ambulatory outcomes in traumatic conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are important yet under-described. Objective: This review aimed to determine the ambulatory outcomes of patients with traumatic CMS and CES, and to identify the clinical factors affecting these outcomes. Methods: PubMed, EMBASE, CINAHL, and Cochrane databases were searched from database inception to August 2021. The searches were limited to articles in English language, human studies, and adult populations. Abstracts, letters, commentaries, editorials, conference posters, case series, case reports, and pilot studies were excluded. Two independent reviewers screened the studies, extracted relevant data regarding the ambulatory outcomes, and evaluated the risk of bias using the Joanna Briggs Institute critical appraisal checklist. If consensus could not be reached, a third reviewer arbitrated. Results: Three articles with a total of 993 participants were analysed. The risk of bias was moderate in two studies and low in one study. The descriptions of ambulatory outcomes were heterogeneous. 111 out of 214 (52%) of the patients with traumatic CES achieved independent walking after rehabilitation. Data regarding walking ability in patients with traumatic CMS were lacking. Improvements in lower limb strength and functional mobility were similar in patients with traumatic CES and those with traumatic CMS. Early rehabilitation, less severe injuries, and lower neurological injury levels are associated with more favourable ambulatory outcomes. In view of the heterogeneity of ambulatory outcomes in the included studies, meta-analysis was not conducted. Conclusions: The ambulatory outcomes of patients with traumatic CMS and CES were heterogeneous with more data available for CES. There is no evidence to suggest that traumatic CMS survivors have worsened motor and mobility prognoses than survivors with traumatic CES.