Cauda Equina Syndrome Assessment, Diagnosis, and Management: Results from a Neurosurgical Unit from 1-year Retrospective Series—Is Our Referral System Effective?

Abstract

Cauda equina syndrome (CES) is a rare occurrence, and its clinical presentation is often vague, mimicking other neurological or medical conditions. In our service area, general practitioners (GPs) and/or the A&E Department directly refers patients to the neurosurgical service. Initial assessment is delegated to neurosurgical and radiology specialists, basing on clinical symptoms and signs. In cases where the radiological investigations come back not suggestive of true cauda equina compression, medical management of the patients' symptoms and signs can be problematic, and often delays the discharge. We performed an analysis of the whole process of assessment and treatment of patients admitted with symptoms and signs of CES. We retrospectively reviewed all the data concerning referrals and admissions for CES in our department. Both patients' clinical details and referral details were considered and critically analyzed. In 1 year examination period, a total number of 93 patients were referred to our department. Out of this number, 69 patients were admitted in the department for clinical and radiological assessment, and treatment. Eight patients required emergency surgical decompression for CES. The mean time between referral and decompression in this group was 36 hours. The average length of hospital staying was 3 days and 16 hours (40 minutes to 1 month and 10 days). We identified several areas of possible service improvement. The clinical and radiological assessments might benefit from a standardized algorithm based on all possible presentations seen in our series and reported in literature. Aiming for better timing of transports, diagnosis, and surgical treatment, as well as more rapid bed turnover in the acute ward could also increase service efficiency and reduce costs.