Cauda equina syndrome\u2014a practical guide to definition and classification

Chris Lavy,Paul Marks,Nicholas Todd,Katerina Dangas

doi:10.1007/s00264-021-05273-1

Chris Lavy, Paul Marks + Show 2 more

Open Access

https://doi.org/10.1007/s00264-021-05273-1

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Abstract

PurposeInternational uniformity of definition and classification are crucial for diagnosis and management of cauda equina syndrome (CES). They are also useful for clinicians when discussing CES with patients and relatives, and for medicolegal purposes.MethodsWe reviewed published literature using PubMed on definition and classification of cauda equina syndrome since 2000 (21 years). Using the search terms ‘cauda equina’ and ‘definition’ or ‘classification’, we found and reviewed 212 papers.ResultsThere were 17 different definitions of CES used in the literature. There were three well-defined methods of classification of CES. The two-stage system of incomplete CES (CESI) versus CES with retention (CESR) is the most commonly used classification, and has prognostic value although the details of this continue to be debated.ConclusionWe used the existing literature to propose a clear definition of CES. We also drew on peer-reviewed published literature that has helped to amplify and expand the CESI/CESR dichotomy, adding categories that are both less severe than CESI, and more severe than CESR, and we propose clear definitions in a table form to assist current and future discussion and management of CES.

Highlights

Cauda equina syndrome (CES) is a rare but important condition whose commonest cause is massive lumbar disc herniation compressing the roots of the cauda equina in the lower lumbar spinal canal [1]
The purpose of this paper is to review recent literature, to put forward a clear and useful definition of CES, and a clear outline of peer-reviewed clinical classification terminology that will be helpful as a baseline to all parties involved in the management and review of cauda equina cases
The proximal constituents of the cauda equina comprise components of the L3, L4, L5 and S1 roots. Dysfunction of these roots mainly affects the legs and does not result in what is known as ‘cauda equina syndrome’ which historically is only used to describe the results of dysfunction of the nerve roots below S1, namely S2, S3, S4 and S5

Summary

Introduction

Cauda equina syndrome (CES) is a rare but important condition whose commonest cause is massive lumbar disc herniation compressing the roots of the cauda equina in the lower lumbar spinal canal [1] (see Fig. 1). There are significant legal and financial consequences for treating clinicians and health institutions as litigation for cauda equina syndrome is increasing [2]. [5,6,7,8,9], and these cover crucial issues in terms of CES management, it is not the purpose of this short paper to consider these. In order to have constructive conversation with patients and their families, between clinicians, and with legal experts, it is important to have a clear definition of CES, and defined terminology for the stages and types of CES. The purpose of this paper is to review recent literature, to put forward a clear and useful definition of CES, and a clear outline of peer-reviewed clinical classification terminology that will be helpful as a baseline to all parties involved in the management and review of cauda equina cases

Methods

Results and discussion on definition

Results and discussion on classification