Cauda Equina Syndrome Research Articles

Definition and surgical timing in cauda equina syndrome-An updated systematic review.

Systematic review. To conduct a systematic review identifying existing definitions of cauda equina syndrome (CES) and time to surgery in the literature for patients with CES. A systematic review was conducted in accordance with the PRISMA statement. Ovid Medline, Embase, CINAHL Plus, and trial registries were searched from October 1st, 2016, to 30th December 2022, and combined with articles identified from a previous systematic review by the same authors (studies published 1990-2016). A total of 110 studies (52,008 patients) were included. Of these only 16 (14.5%) used established definitions in defining CES, including Fraser criteria (n = 6), British Association of Spine Surgeons (BASS) (n = 5), Gleave and MacFarlane (n = 2), and other (n = 3). Most reported symptoms were urinary dysfunction (n = 44, 40%%), altered sensation in the perianal region (n = 28, 25.5%) and bowel dysfunction (n = 20, 18.2%). Sixty-eight (61.8%) studies included details on time to surgery. There was an increase in percentage of studies defining CES published in the last 5 years compared to ones from 1990-2016 (58.6% vs 77.5.%, P = .045). Despite Fraser recommendations, substantial heterogeneity exists in reporting of CES definitions, and a start point for time to surgery, with most authors using self-defined criteria. A consensus is required to define CES and time to surgery, to allow consistency in reporting and study analysis.

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

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.

Diagnosis and Treatment of Cauda Equina Arachnoiditis, a Rare Manifestation of Tuberculosis Meningoencephalitis: A Case Report

Tuberculous meningoencephalitis (TM) is an acute, progressive form of tuberculosis (TB). The epidemiology, clinical signs, and diagnosis of TB are well established, but several atypical forms of tuberculous spinal arachnoiditis can be easily misdiagnosed. We report a rare case of TM with cauda equina arachnoiditis diagnosed by magnetic resonance imaging and an electrodiagnostic study. A 26-year-old otherwise healthy male patient experienced fever, headache, gait disturbance, and bladder and bowel incontinence. Needle electromyography (EMG) recordings were suggestive of bilateral diffuse lumbar and lumbosacral polyradiculopathy, and the pudendal sensory-evoked potential and bulbocavernosus reflex latencies were prolonged. Lumbar arachnoiditis is a rare clinical condition that warrants a heightened index of suspicion. It has diverse etiologies and symptoms, and it can lead to potentially serious and irreversible disorders. This case illustrates the usefulness of nerve conduction, EMG, and pudendal sensory-evoked potential and bulbocavernosus reflex latency studies in the diagnosis of cauda equina syndrome induced by TB arachnoiditis.

The Most Impactful Articles on Cauda Equina Syndrome.

Cauda equina syndrome (CES) is an uncommon condition that can lead to permanent neurological deficits if not diagnosed and addressed promptly. Varying prognoses, including retropulsed fracture fragments, disc herniations, and epidural abscesses, can result in CES. Our objective was to identify the top 50 most impactful articles on CES and analyze the characteristics of these publications. In August of 2021, we used the Web of Science Core Collection bibliographic database to query the phrase "cauda equina syndrome." Articles between 1900 and 2021 were included in the search, and these articles were ranked based on the number of citations. The following variables were recorded: title, first author, journal, year of publication, number of citations, country of origin, the institution of publication, and topic of the paper. A total of 2096 articles matched the search criteria. The top 50 most impactful articles ranged from 43 to 439 in their number of citations. All articles on the list were published in English, with the year of publication ranging from 1938 to 2014. The United States accounted for the greatest number of articles published at 27. The medical journalSpine accounted for the greatest number of publications at nine. And the 2000s was the decade with the most cited articles. It is generally acknowledged that the clinical signals for CES are diverse with no predictive value on patient outcomes. Similar uncertainty exists in the etiology of the condition, though CES induced by spinal anesthesia is a factor of particular interest. Additionally, it is generally recognized that delayed diagnosis of the condition often results in permanent neurological deficits. Identification of the most impactful articles on CES is critical in drawing attention to this significant condition.

Lumbar Calcifying Pseudoneoplasm as a Rare Cause of Cauda Equina Syndrome: A Case Report

A calcifying pseudo-tumor of the spine, also called calcifying pseudoneoplasm of the neuraxis (CAPNON), is a rare non-neoplastic lesion that can occur anywhere in the central nervous system. Although CAPNON shows tumor-like behavior, it is believed to be benign and of inflammatory-reactive origin. It may cause many neurologic symptoms by compressing adjacent structures. We report the case of a 45-year-old man who presented with cauda equina syndrome. Magnetic resonance imaging revealed a partially calcified mass compressing the spinal cord. Gross total resection was carried out and the patient’s symptoms improved. Histopathology proved that the mass was CAPNON. Although spinal localization of CAPNON is rare, we should know and recognize this entity based on appropriate imaging findings because radical excision has an excellent prognosis.

A Systematic Review of the Usage of Lidocaine in Hip Replacement Surgery.

Hip replacement procedures, professionally known as hip arthroplasty, are one of the most common orthopedic procedures. Due to the variation in this procedure, the use and types of anesthetics differ. One such commonly used anesthetic is lidocaine. Since there are currently no standardized or general procedures for the application of lidocaine for perioperative hip arthroplasty procedures, this review aims to delve into this topic. A literature review surrounding the key terms "hip replacement" and "lidocaine" was performed on PubMed. After reviewing 24 randomized control trials, statistical analyses between groups that had no lidocaine versus groups that did were performed. The results showed that there was no statistical significance between various age groups and the use of lidocaine. One percent (1%) and 2% injected into the lumbar region were the most commonly reported doses of lidocaine, with 2% often being the first test dose. Other conclusions were that lidocaine was used for general anesthesia for individuals that underwent hip arthroplasty due to an underlying condition (cauda equina syndrome, ankylosing spondylitis, etc.). Lidocaine was also used for postoperative pain relief, which is a potential concern from its addictive qualities. This investigation outlines the current stance and usage of lidocaine in perioperative hip arthroplasty while noting its limitations.

Full-Endoscopic Isolation Zone Technique for the Treatment of Lumbar Disc Herniation.

Lumbar disc herniation (LDH) is a type of serious sinus or sciatic nerve dysfunction caused by nucleus pulposus protrusion and annulus fibrosus tears. Its clinical symptoms often include severe low back pain, limited lumbar movement, sciatic nerve pain in the lower limbs, and even cauda equina syndrome. The common treatment for LDH is a conservative treatment scheme involving medicine, rest, and physical therapy. However, if the conservative treatment scheme is ineffective, a surgical treatment approach is adopted. Traditional open lumbar surgery has some disadvantages, including the potential for severe surgical trauma, severe blood loss during the operation, instability of the lumbar spine, and loss of the lumbar motor unit. Among the minimally invasive surgical schemes, full-endoscopic spine surgery (FESS) is undoubtedly the most appropriate and has the advantages of minimal trauma, high safety, quick postoperative recovery, and the retention of the stable structure and the motor unit of the lumbar spine. However, simultaneously, incomplete removal of the nucleus pulposus and residual nerve dysfunction after surgery can occur. To avoid these shortcomings, we studied a specific spinal endoscopy technique, the "isolation zone" surgical strategy, which can effectively block the pain from the nerve conduction pathway by completely relieving the nerve compression and nerve dysfunction through the orderly treatment of the protruding nucleus pulposus, the fissure of the annulus fibrosus, the sinus nerve, and the surrounding inflammatory soft tissues.

More questions than answers to the diagnosis and management of cauda equina syndrome.

More questions than answers to the diagnosis and management of cauda equina syndrome.

Neurophysiological Effects of Electrical Stimulation on a Patient with Neurogenic Bowel Dysfunction and Cauda Equina Syndrome after Spinal Anesthesia: A Case Report

Neurogenic bowel dysfunction (NBD) is common in patients with cauda equina syndrome (CES). Previous studies have reported that electrical stimulation (ES) improves NBD but more neurophysiologic evidence is required. This case report describes a patient who experienced difficulty with defecation as a result of cauda equina syndrome (CES) that developed after a cesarean section performed 12 years ago under spinal anesthesia. The neurophysiological effects were assessed using the bulbocavernosus reflex (BCR) and electromyography (EMG). Two ES treatments, interferential current therapy and transcutaneous electrical stimulation, were used to stimulate the intestine and the external anal sphincter, respectively. The BCR results showed right-side delayed latency and no response on the left side. Needle EMG revealed abnormal spontaneous activities of the bilateral bulbocavernosus (BC) muscles. Electrodiagnostic testing revealed chronic bilateral sacral polyradiculopathy, compatible with CES. After treatment, the patient reported an improved perianal sensation, less strain and time for defecation than before, and satisfaction with her bowel condition. At the follow-up electrodiagnosis, the BCR latency was normal on the right side-needle EMG revealed reductions in the abnormal spontaneous activities of both BC muscles and re-innervation of the right BC muscle. Electrodiagnostic testing can offer insight into the neurophysiological effects of ES, which can help in understanding the mechanism of action and optimizing the therapy for patients with NBD.

Rehabilitation Characteristics Predicting Post-Operative Discharge Location after Surgery for Cauda Equina Syndrome: A Retrospective Analysis

Rehabilitation Characteristics Predicting Post-Operative Discharge Location after Surgery for Cauda Equina Syndrome: A Retrospective Analysis

Cauda Equina Syndrome and Spinal and Epidural Anesthesia. The Influence of Local Anesthetic, Needle Type and Position of Puncture

Background and Objectives: Severe complications such as Cauda Equina Syndrome (CES) lead to temporary or permanent disability have been ascribed to central neuraxial blocks. Some case reports, and very few retrospective studies, have focused their attention on the fact that central nerve blocks can cause, albeit rarely, permanent damage to the spinal cord or nerve roots, or both. This study is the experience of 48 years with spinal anesthesia and several publications and no definite neurological complications. This study is not a review of the subject. The primary objective of this study was to analyze the characteristics in relation to needles, puncture position, types of anesthetics, and baricity of local anesthetics.

Full-Endoscopic Interlaminar Approach for Decompression of Lateral Recess Stenosis.

For lateral recess stenosis, extensive decompression with laminectomy is still performed in most centers. However, tissue-sparing surgeries are becoming more common. Full-endoscopic spinal surgeries have the advantages of being less invasive and offering a shorter recovery time. Here, we describe the technique of the full-endoscopic interlaminar approach for the decompression of lateral recess stenosis. The full-endoscopic interlaminar approach for the lateral recess stenosis procedure took approximately 51 min (range of 39-66 min). Blood loss could not be measured due to continuous irrigation. However, no drainage was required. There were no dura mater injuries reported in our institution. Furthermore, there were no injuries to the nerves, no cauda equine syndrome, and no hematoma formation. The patients were mobilized on the same day as surgery and discharged the next day. Therefore, the full-endoscopic technique for lateral recess stenosis decompression is a feasible procedure that lowers the operational time, complications, traumatization, and rehabilitation duration.

'Having regard to the findings made by the referrer': medicolegal implications of case SC (2020) for hospital clinicians.

A case concerning the management of a child with meningitis in a hospital paediatrics department provided a judgement that has significant potential implications for medical practice. The case establishes that the examination findings of a previous clinician must be taken into account when investigating and treating patients. This case is of medicolegal relevance to clinicians practising in tertiary centres and who receive patients from other hospitals. This article highlights the medicolegal implications of this case, using an example of cauda equina syndrome for neurosurgeons, a condition that can have fluctuating symptomatology and that already has a high burden of litigation.

Primary lumbosacral intradural hydatid cyst revealed by a cauda equina syndrome

Hydatid disease is a serious public health problem in developing countries. Spinal hydatid cysts account for 1% of all cases of hydatid disease and the primary intradural extramedullary hydatid cyst is exceptional. We report a case of 75-year-old women presented with a history of backache, leg pain, difficulty in walking, and bladder incontinence. Thoraco-lumbar MRI has showed an intradural process extending from L2 to S5, a low intensity signal on T1 weighted images and a high-intensity signal on T2 weighted images, which were not enhanced after gadolinium injection. There was no vertebral involvement. The patient underwent surgery, by a posterior approach we perform L2S1 laminectomy. After opening the dura multiple vesicles were found scattered among the roots, with no adhesion to meninges or nervous structures. The outcome was good. Albendazole therapy is obligatory.

A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy

This study examined the incidence and severity of adverse events (AEs) of patients receiving chiropractic spinal manipulative therapy (SMT), with the hypothesis that < 1 per 100,000 SMT sessions results in a grade ≥ 3 (severe) AE. A secondary objective was to examine independent predictors of grade ≥ 3 AEs. We identified patients with SMT-related AEs from January 2017 through August 2022 across 30 chiropractic clinics in Hong Kong. AE data were extracted from a complaint log, including solicited patient surveys, complaints, and clinician reports, and corroborated by medical records. AEs were independently graded 1–5 based on severity (1-mild, 2-moderate, 3-severe, 4-life-threatening, 5-death). Among 960,140 SMT sessions for 54,846 patients, 39 AEs were identified, two were grade 3, both of which were rib fractures occurring in women age > 60 with osteoporosis, while none were grade ≥ 4, yielding an incidence of grade ≥ 3 AEs of 0.21 per 100,000 SMT sessions (95% CI 0.00, 0.56 per 100,000). There were no AEs related to stroke or cauda equina syndrome. The sample size was insufficient to identify predictors of grade ≥ 3 AEs using multiple logistic regression. In this study, severe SMT-related AEs were reassuringly very rare.

Non-surgical treatment of giant tumor-like lumbar disc herniation based on enhanced MRI: A case series.

In recent clinical follow-up, it has been vertified that resorption in lumbar disc herniation (LDH) could be of great curative effect in non-surgical treatment for LDH. However, reports of resorption in giant tumor-like LDH are rarely mentioned due to its risk of irreversible neurological damage which could be caused by long-term non-surgical treatment. In our clinical observations, we have found that enhanced MRI helps to distinguish LDH from intradural tumours and to predict the probability of resorption in LDH. We analyzed 8 patients with giant tumor-like LDH who underwent non-surgical treatment, and these patients had resorption during follow-up. All patients were examined with enhanced MRI before treatment, and the type of "bull's eye" sign classification was determined by images. The MRI protrusion volume(VP), resorption rate(HR%) and JOA score of patients at the first visit and the last follow-up were recorded. 8 patients of Han ethnicity were admitted to the department of orthopedic complaining of low back pain for 1week to 12months. They were diagnosed with giant tumor-like LDH by enhanced MRI. These patients were diagnosed with giant tumor-like LDH. We adopted a non-surgical treatment plan for the patients, including taking oral non-steroidal anti-inflammatory agents and performing rehabilitation exercise. In consideration of the risk of irreversible neurological damage, patients were closely observed during treatment and follow-up. Once the following conditions occur, surgical treatment is required immediately: The symptoms are not signifcantly relieved after 3 to 6 months of non-surgical treatment; The symptoms are aggravated by non-surgica treatment; The clinical manifestations of cauda equina syndrome. After treated with oral non-steroidal anti-inflammatory agents and rehabilitation exercise, the resorption was accompanied by clinical symptom relief. No neurological damage occurred in all patients, and the clinical symptoms did not recur in the subsequent follow-up. Clinicians should fully consider the possibility of resorption prior to surgical treatment in patients with giant LDH. We can predict the probability of resorption in patients with giant LDH based on enhanced MRI. For patients with a high probability of resorption, we can choose non-surgical treatment in the absence of progressive neurological impairment and cauda equina syndrome.

Minimally invasive decompression alone versus fusion surgery for acute lumbar disk herniation combined incomplete cauda equina syndrome

Study designRetrospective single center study. BackgroundCauda equine syndrome (CES), which caused by acute lumbar disc herniation (LDH), often requires urgent surgical treatment. Currently, there is no standard defining the type of surgery, and approaches to the treatment of patients are based on the experience of the surgeon. Purposeto compare the clinical efficacy of minimally invasive decompression alone (Decompression alone group) and transforaminal lumbar interbody fusion (Fusion group) in the treatment of the incomplete CES, caused by acute LDH. Patients and methods89 patients with acute incomplete CES associated with LDH either underwent decompression alone and fusion surgery from January 2005 to January 2020 in single-center, and data were collected and retrospectively analyzed. The patients were divided into 2 groups according to the operation technics: the Decompression alone group (n = 46) and the Fusion group (n = 43). The perioperative clinical data (neurological deficit, control of the urinary bladder sphincter, ODI scale, SF-36) was used to assess the efficacy of the respective surgical methods before operation and with a minimum follow-up 24 months. ResultsVerified statistical significance more bleeding, longer surgery time and hospital stay, in the Fusion group than in the Decompression alone group. The postoperative clinical data dramatic improved after Decompression alone and Fusion surgery. At early postoperative period registered better clinical outcomes according to ODI, SF-36 after Decompression alone surgery, but at minimum follow-up 24 months verified better in the Fusion group. The number of revision interventions in the Decompression alone group was 28.3% (n = 13), in Fusion group – 9.3% (n = 4) (p = 0.02). ConclusionsThe prevalence of acute incomplete CES due to LDH in our series was registered in 1.02% of patients (124 of 12087). In the Fusion group, in the long-term period, there were better clinical outcomes and fewer revision surgical interventions compared with Decompression alone.

Characteristics and clinical features of cauda equina syndrome: insights from a study on 256 patients.

To determine the frequency, clinical presentation, and etiological factors of cauda equina syndrome (CES). This retrospective study was done on 256 participants, and aimed to analyze the frequency and patterns of clinical presentation in suspected cases of CES. The inclusion criteria included participants aged 18 or older with medical records available for review and having red-flagged symptoms for CES. The study collected information on various factors such as age, gender, confirmation of CES on MRI, neurological deficits, etiological factors, duration of symptoms, and more. The data collected was analyzed using descriptive statistics and logistic regression to identify significant variables between MRI-proven CES and suspected CES. The mean age was 58.05±19.26years, with 151 females (58.98%) and 105 males (41.02%). The majority (50.78%) had a neurological deficit, while other symptoms included difficulty initiating micturition or impaired sensation of urinary flow (17.58%), loss of sensation of rectal fullness (3.12%), urinary or faecal incontinence (35.16%), bilateral sciatica (21.88%), neurological symptoms in the lower limbs (25.00%), anaesthesia or any leg weakness (24.22%), and bilateral sciatica as the predominant symptom (21.88%). Symptoms were chronic in 47.27% and acute in 21.88%. The odds of MRI-proven CES increase by 3% per year of age. Neurological deficit was strongly associated with MRI-proven CES (OR=14.97), while loss of sensation of rectal fullness increased the odds by 10-fold (OR=10.62). CES can present with various symptoms, including the bilateral neurological deficit, urinary and faecal incontinence, and bilateral sciatica, with age, severe bilateral neurological deficit, and loss of sensation of rectal fullness being associated with MRI-proven CES. Early diagnosis and treatment are crucial for better outcomes.

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 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 48h. 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.

Transverse myelitis and cauda equina syndrome followed by varicella in a patient with varicella-zoster virus infection

A 74-year-old man was admitted to our hospital with complaints of weakness in the lower extremities, urinary retention for 10 days, and generalized vesicular rash for 7 days. Spinal magnetic resonance imaging showed contrast enhancement at the Th12-L1 level of the spinal cord and cauda equina. Serum and cerebrospinal fluid varicella-zoster virus (VZV)-immunoglobulin (Ig) G antibody titers were markedly elevated, and VZV-IgM was detected in cerebrospinal fluid. The patient was diagnosed with VZV transverse myelitis and cauda equina syndrome with subsequent varicella and was treated with acyclovir and prednisolone. Two months later, muscle weakness, and dysuria had almost completely resolved. We hypothesize that latent VZV in the ganglia reactivated and caused transverse myelitis, which subsequently spread to the body via the bloodstream, resulting in the development of varicella.