Symptoms Of Cauda Equina Syndrome Research Articles

Post-traumatic hemorrhage in a large sacral Tarlov cyst causing acute radiculopathy

Symptomatic Tarlov cysts (TCs) are an under-recognized clinical entity that should be considered in the differential for lower back pain. These are more common in women and can also be a cause of pelvic pain. Hemorrhagic TCs have been rarely reported in the literature, with symptoms ranging from lower back pain and radiculopathy to symptoms of cauda equina syndrome. We report on a female patient in her 50s who presented with radicular symptoms as a consequence of TC hemorrhage. Magnetic resonance imaging is the gold standard investigation, and this showed post-traumatic hemorrhage causing irritation of the sciatic nerve. Hemorrhagic TC is an important differential to consider in the setting of acute radicular pain, and the symptoms can be resolved with conservative management.

Role of Panchakarma in the Management of Spinal Canal Stenosis - A Case Study

Spinal canal stenosis is a painful, degenerative condition, and is localized to facets, joints, and ligamentum flavum of the vertebra which is often referred to for surgical correction. The main cause of stenosis is herniated vertebral disc. If there is no compression, the spinal canal can be referred to as narrow, but not stenotic. Certain studies have defined lumbar spinal stenosis as the narrowing of the osteo-ligamentous vertebral canal or the intervertebral foramina, which causes compression of the thecal sac or the caudal nerve roots. The narrowing may impact the entire canal or just a portion of it, but it occurs at a single vertebral level. In this condition, it may, drastically affect the quality of life due to severe pain in doing daily routine activities. In contemporary science, there is no treatment except surgical intervention which is having a high chance of complication and the chances of recurrence. Surgery is necessary when there are clinically significant motor deficiencies or symptoms of cauda equina syndrome. Based on the manifestation of clinical signs and symptoms it can be correlated with Gridhrasi, according to Ayurveda. Gridhrasi can be treated successfully by the intervention of Panchakarma procedures along with Shamana Chikitsa. Here is a case study of a patient suffering from low back pain radiating to bilateral lower limbs, stiffness, numbness, burning sensation in the bilateral sole region, and unable to walk without support, who was previously diagnosed as a case of Spinal Canal Stenosis. He was treated with a Panchakarma procedure, Shamana Chikitsa along with Physiotherapy Exercises. The patient showed marked improvement and could do daily routine activities properly.

WHEN CANCERS COLLIDE: A COLLISION TUMOR OF ADENOCARCINOMA AND SMALL CELL CARCINOMA OF THE LUNGS

WHEN CANCERS COLLIDE: A COLLISION TUMOR OF ADENOCARCINOMA AND SMALL CELL CARCINOMA OF THE LUNGS

Comparative Study of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Treating Cauda Equina Syndrome

Objective: The purpose of this study is to evaluate the clinical outcome of cauda equina syndrome (CES) using percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM).Methods: Fifteen patients with CES either underwent PELD or OLM from January 2017 to December 2019. The patients were divided into 2 groups according to the surgical methods: the PELD group (with 7 patients, 5 males and 2 females) and the OLM group (with 8 patients, 6 males and 2 females). The clinical outcomes were evaluated by the Visual Analogue Scale score (VAS), motor grade of lower extremities, perineal sensation, anal tone, and bladder dysfunction. Results: Both groups reported a significant postoperative reduction of VAS score for back and leg pain. When comparing the two groups, there was no significant difference in the improvement of leg pain. However, the improvement in back pain was significantly higher in the PELD group than in the OLM group (p=0.05). In the PELD and OLM groups, all 15 patients showed an improvement in preoperative CES symptoms including impaired lower limb motor power, perineal sensations, anal sphincter tone and bladder function at the one-year follow-up. The operation time (p=0.01) and length of hospital stay (p=0.01) were shorter in the PELD group compared with the OLM group. In the PELD group, the intraoperative bleeding was negligible whereas in the OLM group.Conclusion: The advantages of PELD, indicate it is a good alterative or option for the treatment of CES patients considering the appropriate indication.

Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF) Compared with Open TLIF for Acute Cauda Equina Syndrome: A Retrospective Single-Center Study with Long-Term Follow-Up

In a retrospective study, we sought to compare the clinical efficacy and postoperative magnetic resonance imaging (MRI) scans of minimally invasive (MI) and open (O) transforaminal lumbar interbody fusion (TLIF) in the treatment of cauda equina syndrome (CES) caused by lumbar disc herniation. In total, 116 patients with CES associated with disc herniation underwent decompression and stabilization surgery from January 2005 to January 2020 in a single-center study, and data were collected and retrospectively analyzed. The patients were divided into the O-TLIF and the MI-TLIF group. The perioperative clinical data and MRI assessment were used to assess the efficacy of the respective surgical methods preoperatively and with a minimum follow-up of 30 months. As expected, the O-TLIF group had statistically significantly longer surgery times and hospital stay, more bleeding, and perioperative surgical complications than the MI-TLIF group. At a minimum follow-up period of 30 months, the MI-TLIF group had significantly better Oswestry Disability Index, visual analog scale, and Short-Form-36, and neurologic CES symptoms than the O-TLIF group. The postoperative MRIs revealed a statistically significant difference in the multifidus muscle area in MI group compared with the O group. In patients with acute CES caused by disc herniation, MI-TLIF, with decreased disruption of paravertebral tissues and postoperative pain syndrome, results in earlier mobilization and rehabilitation with better long-term clinical outcomes compared with O-TLIF.

Cauda Equina Syndrome Outcome: Early V/S Late Surgery

There is no reservation that the superlative result for Cauda Equina Syndrome (CES) requires decompression by surgery. Objective: The goal of our study was to determine the effect of surgical procedure, with relation to time, on bladder and bowel symptoms. Methods: A retrospective analysis of patients undergoing surgical decompression by CES was done. The subjects with persistent symptoms were surveyed for at least two-years. BASS criteria were applied to classify CES: painless urinary retention (CESR), incomplete (CESI) and CES suspicious (CESS). The resolution of presenting autonomic symptoms was assessed following surgery. Results: A total of 120 patients were confirmed with CES and referred for surgery. Surgical treatment included all cases of laminectomy or lumbar discectomy. 60 patients reported CESR, 24cases of CESI and 36 cases of CESS. No statistical alteration in sex, age, alcohol comorbidities score and smoking by the time of surgery was noted. All patients with CESR and CESI showed a positive response in bladder and bowel dysfunction following surgery. There was no substantial change in the recovery of autonomic dysfunction associated with the time of surgery. Conclusions: Surgical decompression is an operative method of treatment that suggestively alleviates the symptoms of CES involved autonomic system. Early decompression by surgery 24 hours after start of symptoms does not seems to improve resolving of bladder or bowel dysfunction significantly

The clinical features and prognosis of scan negative uro-neurological disorders

BackgroundMore than 50% of patients presenting with cauda equina syndrome (CES) have normal imaging. These patients require phenotyping to ascertain symptom aetiology and mechanism.Prospective Study Results198 patients presented with suspected CES over 28 months. 47 were diagnosed with ‘scan-positive’ CES (mean age 48yrs, 43% female). 76 patients had evidence of nerve root compres- sion or displacement and were placed into a ‘mixed’ category (mean age 46yrs, 71% female) and 61 patients had normal scans ‘scan-negative’ CES (mean age 40yrs, 77% female). Fourteen patients had a neurological diagnosis explaining their clinical CES symptoms during admission.Patients with ‘scan-positive’ CES were more likely to have reduced or lost bilateral ankle jerks (78% vs. 30% and 12%, p≤0.0001). Patients with ‘scan-negative’ CES were found to have positive signs of a functional neurological disorder on examination (11% v. 34% and 68%, p≤0.0001) as well as high rates of panic, medication usage and psychopathology. Four patients out of 151 (4%, mixed group n=3, ‘scan-negative’ group n=1) had a neurological diagnosis after discharged which potentially explained their clinical CES presentation.ConclusionsThis is the first well phenotyped, prospective study of patients with ‘scan-negative’ CES dem- onstrating a pain, medication and functional mechanism of symptom production.ingrid.hoeritzauer@ed.ac.uk

Long term clinical outcome following decompressive surgery for Cauda Equina Syndrome

Study design: Retrospective study with prospective long-term clinical follow-up.
 Background: Cauda equina syndrome (CES) is a neurosurgical emergency, mostly caused by herniated lumbar disc for which urgent surgical decompression is indicated. Data on long-term clinical outcome of bladder, bowel & sexual function following decompression are elusive.
 Aim: To evaluate the effectiveness of surgical decompression on recovery of CES symptoms at long-term follow-up & role of timing of surgery on the outcome.
 Methods: Records of 35 CES patients who underwent surgical decompression for herniated lumbar disc during a five years period retrospectively analysed & patients called for follow-up visits. Outcome measures comprised of history & clinical examination pertinent to bladder, bowel & sexual function.
 Results: Twenty-four patients (68.5%) were included for final evaluation who attended follow-up visits, with a minimum follow-up period of one year. Most common complaint at presentation was bladder dysfunction (100%) with urinary retention in 16 patients (66.6%), faecal incontinence in 11 (45.8%), saddle anaesthesia in 22 (91.6%) & erectile dysfunction in 6 patients (out of 15 males). Only four patients underwent surgery within 48 hours of CES symptom onset, rest cases after 48 hours duration. At follow-up, bladder dysfunction present in 33.3% with urinary retention in 16.6%. Faecal incontinence persisted in 4 patients (16.6%) & saddle anaesthesia in 7 (29.1%). Sexual dysfunction was the most persistent complaint.
 Conclusion: Long-term follow-up shows significant recovery of sphincteric function in CES patients after surgical decompression. Urinary & bowel dysfunction improve significantly. Timing to surgery didn’t affect the long-term outcome.

Anaplastic pilocytic astrocytoma of the cerebellum presenting with conus medullaris drop metastasis

Due to its rarity, a complete understanding of the clinical behavior, pathogenesis, and diagnostic definition of anaplastic pilocytic astrocytoma (APA) is currently lacking. The optimal clinical management and use of adjuvant therapies has yet to be defined. We present a 64 year-old-female with progressive headaches, dysarthria, and ataxia, who was found to have right cerebellar mass. A gross total resection was achieved through two staged operations. Pathology demonstrated focal areas of necrosis, tumor infiltration, and increased mitotic activity most consistent with APA. Adjuvant chemotherapy and stereotactic radiosurgery were administered. Approximately two years later, the patient presented with symptoms of cauda equina syndrome, and lumbar spine imaging demonstrated a large intradural mass at the conus medullaris with diffuse leptomeningeal enhancement. A biopsy was performed and was consistent with metastatic APA. APA may rarely progress to metastatic disease, most frequently involving the leptomeninges of the posterior fossa and cervical spine. This report represents the first case of metastases distal to the cervicomedullary junction.

Suspected cauda equina syndrome: no reduction in investigation, referral and treatment during the COVID-19 pandemic.

Compression of the cauda equina can lead to bladder, bowel and sexual dysfunction with lower limb pain, numbness and weakness. Urgent surgical decompression aims to prevent progressive neurological deficit. Symptoms of cauda equina syndrome (CES), such as back pain, sciatica and bladder dysfunction are common in the population, but the majority of those investigated do not have radiological cauda equina compression. However, a missed diagnosis can have significant medical, social and legal consequences. We investigated the effect of the COVID-19 pandemic on presentation and management of suspected CES. This retrospective cohort study analysed referral, investigation and treatment of CES in a regional neurosurgical centre during the initial COVID-19 surge between March and May 2020 compared with March to May 2019. Referrals for suspected CES were similar during the COVID-19 pandemic (n = 275) compared with 2019 (n = 261, p = 0.596) despite a significant (19%) decrease in total emergency neurosurgical referrals (1248 in 2020 vs 1544 in 2019, p < 0.001). Nineteen (7%) of the suspected CES referrals underwent decompression in 2020, similar to 16 (6%) in 2019 (p = 0.867). There were no differences in outcomes or complications and no evidence of delays in presentation or treatment. Unlike other emergency neurosurgical conditions, the number of referrals for suspected CES and the percentage of referrals with radiological cauda equina compression were unchanged during the COVID-19 pandemic. The persistence of CES referrals when many people stayed away from hospital highlights the distress and worry caused by suspected CES and its symptoms to both patients and healthcare providers.

Full Endoscopic Lumbar Discectomy Versus Laminectomy for Cauda Equina Syndrome.

Typically, open surgery is advocated for cauda equina patients. The goal of this study was to compare the clinical efficacy of full endoscopic lumbar discectomy and laminectomy in the treatment of cauda equina syndrome (CES) caused by lumbar disc herniation. Forty-three patients with CES either underwent endoscopic or laminectomy surgery from May 2015 to April 2016, and data were collected and retrospectively analyzed. The patients were divided into 2 groups according to the surgical methods: the endoscopy group (with 21 patients, 14 males and 7 females, and an average age of 42.67 with a standard deviation of 9.70 years) and the laminectomy group (with 22 patients, 16 males and 6 females, and an average age of 44.55 with a standard deviation of 9.36 years). The modified Japanese Orthopaedic Association (JOA) "leg-trunk-bladder" score was used to assess the efficacy of the respective surgical methods. Analysis showed longer surgery time, more bleeding, and longer hospital stay in the laminectomy group than in the endoscopy group with statistical significance. The postoperative JOA scores improved in both groups when compared with those before the operation, and the differences were statistically significant. There were no significant differences in JOA scores between the 2 groups at preoperation and 6-month and 1-year follow-ups. There was 1 patient in each group whose CES symptoms worsened after endoscopy. However, immediate reoperation resulted in satisfactory outcomes. CES clinical symptom resolution was equal with endoscopy and laminectomy both in short-term and midterm follow-up. However, endoscopic treatment was advantageous by reducing the amount of bleeding, duration of surgery, and hospitalization days when compared to laminectomy. 3. Feasibility study Endoscopic Decompression for Cauda Equina.

A service evaluation of patients suspected of Cauda Equina Syndrome referred to accident and emergency departments from a national telephone triage service

BackgroundThe presentation and management of Cauda Equina Syndrome (CES) remains contentious in medical literature, however it is widely agreed that CES requires emergency medical attention. Physiotherapists will often refer suspected cases to A&E departments for emergency medical review in order to safeguard patient safety. ObjectivesTo evaluate the management of patients triaged by a national telephone service referred to A&E for suspected CES. MethodKnown escalations (17 cases) from January 2017 to June 2017 from a national telephone triage service referred to A&E with suspected CES were included. Results53% of cases with CES symptoms that conformed to the BASS definition of having a requirement for diagnostic imaging were not investigated by MRI scan. The MRI and non-MRI groups had similar group sizes (8 : 9) and mean ages (42.4 years ± 8SD and 45.7 years ± 12SD). Overall, there were more females (11) compared to males (6) referred to A&E. ConclusionThere appears to be significant variability in the management of this cohort of patients once referred to emergency departments. Further guidance is needed as to when watchful waiting is clinically appropriate, and what best practice should be to facilitate safe patient management.

Red Flag for Cauda Equina Syndrome in Symptomatic Lumbar Disc Herniation

In a retrospective study, we sought to compare the clinical efficacy and postoperative magnetic resonance imaging (MRI) scans of minimally invasive (MI) and open (O) transforaminal lumbar interbody fusion (TLIF) in the treatment of cauda equina syndrome (CES) caused by lumbar disc herniation.In total, 116 patients with CES associated with disc herniation underwent decompression and stabilization surgery from January 2005 to January 2020 in a single-center study, and data were collected and retrospectively analyzed. The patients were divided into the O-TLIF and the MI-TLIF group. The perioperative clinical data and MRI assessment were used to assess the efficacy of the respective surgical methods preoperatively and with a minimum follow-up of 30 months.As expected, the O-TLIF group had statistically significantly longer surgery times and hospital stay, more bleeding, and perioperative surgical complications than the MI-TLIF group. At a minimum follow-up period of 30 months, the MI-TLIF group had significantly better Oswestry Disability Index, visual analog scale, and Short-Form-36, and neurologic CES symptoms than the O-TLIF group. The postoperative MRIs revealed a statistically significant difference in the multifidus muscle area in MI group compared with the O group.In patients with acute CES caused by disc herniation, MI-TLIF, with decreased disruption of paravertebral tissues and postoperative pain syndrome, results in earlier mobilization and rehabilitation with better long-term clinical outcomes compared with O-TLIF.

Is scan-negative cauda equina syndrome a functional neurological disorder? A pilot study.

Cauda equina syndrome (CES) is a neurosurgical emergency which warrants lumbar magnetic resonance imaging (MRI). Many patients with suggestive symptoms of CES have no radiological correlate. A functional (non-organic) aetiology has been proposed in some, but currently little is known about this patient group and their clinical outcomes. At a tertiary referral centre, 155 adult patients underwent urgent lumbar MRI for suspected CES in 1 year from December 2014. Data regarding clinical symptoms and follow-up were obtained from records. Patients were divided into CES (n=25), radiculopathy (n=68) and scan-negative (SN) groups (n=62) from scans. Up to 3years post-discharge, postal questionnaires were sent to patients with Oswestry Disability Index, Pain Catastrophizing score, Patient Health Questionnaire (PHQ) 9, Generalized Anxiety Disorder (GAD) 7, PHQ 15 and Work and Social Adjustment Scale measures. No clinical symptoms were found to differentiate CES from SN patients. Functional comorbidities were significantly more common in SN patients but mental health diagnosis frequency did not differ. Follow-up was variable with no consistent referral pathways, particularly for the SN group. 33% (n=47) responded to the postal questionnaires; high levels of pain, symptom chronicity and disability were ubiquitous but self-reported mental health diagnoses and PHQ 15 were higher for SN patients. Conflicting data suggest further research is needed to investigate the prevalence of mental illness and somatic symptoms in SN cases. SN patients have higher rates of comorbid functional disorders and inconsistent referral pathways. Self-report measures indicate impaired quality of life across all groups. The low response rate limits the generalizability of findings but neuropsychiatric assessment and care pathway optimization should be considered.

What is the diagnostic accuracy of red flags related to cauda equina syndrome (CES), when compared to Magnetic Resonance Imaging (MRI)? A systematic review

ObjectiveTo review and statistically pool available evidence on the diagnostic accuracy of red flags to clinically identify MRI confirmed Cauda Equina Syndrome (CES). Study designSystematic review. Data sourcesEmbase, Scopus, Ovid Medline, Ovid Healthstar, Amed and CINAHL from inception to January 30, 2018 and a grey literature search. Inclusion criteriaPrimary diagnostic studies, published in English; comparing red flags for CES; to Magnetic Resonance Imaging (MRI) as reference standard; in humans; older than 18 years. MethodsData extraction, assessment of study quality using a modified QUADAS-2 tool and the use of GRADE to synthesize the results for each test was performed by three independent assessors. Diagnostic accuracy statistics applied to the identified data andpooled analysis performed using Meta-DiSc, version 1.4. Moderator analyses planned for pooled results. ResultsSeven studies (total N = 569 participants) were included. Potential signs or symptoms of CES were compared to MRI findings. Diagnostic data could be pooled for reduced anal tone, leg pain, back pain, saddle anaesthesia, urinary retention, urinary incontinence and bowel incontinence from six of seven studies. The pooled sensitivity for the signs and symptoms ranged from 0.19 (95% CI 0.09 to 0.33) to 0.43 (95% CI 0.30 to 0.56) while the pooled specificity ranged from 0.62 (95% CI 0.59 to 0.73) to 0.88 (95% CI 0.85 to 0.92). ConclusionRed flags used to identify potential CES appear to be more specific than sensitive. As such, when these are present, they should be considered justification for prompt diagnostic workup.

Posterior Epidural Migration of a Lumbar Intervertebral Disc Fragment Resembling a Spinal Tumor: A Case Report.

Posterior epidural migration of a lumbar intervertebral disc fragment (PEMLIF) is uncommon because of anatomical barriers. It is difficult to diagnose PEMLIF definitively because of its relatively rare incidence and the ambiguity of radiological findings resembling spinal tumors. This case report describes a 76-year-old man with sudden-onset weakness and pain in both legs. Electromyography revealed bilateral lumbosacral polyradiculopathy with a mass-like lesion in L2-3 dorsal epidural space on lumbosacral magnetic resonance imaging (MRI). The lesion showed peripheral rim enhancement on T1-weighted MRI with gadolinium administration. The patient underwent decompressive L2-3 central laminectomy, to remove the mass-like lesion. The excised lesion was confirmed as an intervertebral disc. The possibility of PEMLIF should be considered when rim enhancement is observed in the epidural space on MRI scans and electrodiagnostic features of polyradiculopathy with sudden symptoms of cauda equina syndrome.

Islands of Inflammation: Neurosarcoidosis

A 27-year-old African American man endured progressively more severe low-back pain for 4 months before he sought treatment. An acute exacerbation during a 4-day period, accompanied by numbness over the right thigh and weakness in both legs, finally spurred a visit to the hospital. Upon questioning, the patient denied bowel or bladder incontinence, saddle anesthesia, or other symptoms of cauda equina syndrome. His maternal grandmother had a history of sarcoidosis, and his maternal aunt had a history of lupus. He smoked 5 cigarettes per day for 8 years and occasionally smoked marijuana but denied use of alcohol or intravenous drugs.

Examination of The Predictive Power of Electromyography and Urodynamic Study in Patients with Cauda Equina Syndrome (Horse Tail Syndrome).

Background:Cauda equina syndrome is a rare disorder that causes loss of Lumbar plexus function (nerve roots) lower than conus medullaris. No risk factor has been defined for this disease yet. Due to the high morbidity of Cauda equina syndrome and lack of sufficient information about the connection between the disease and urodynamic findings and EMG (Electromyography) findings, the need for this comprehensive study is felt.Objective:The aim is to determine the predictive power of findings resulted from urodynamics and electromyography of perineal region and around sphincter in the clinical cure rate of urination in patients with urinary retention followed by Cauda equina syndrome.Method:Patients referred to Shohadaye Tajrish Hospital during the years 2009 to 2013, in case of having Cauda equina syndrome symptoms (confirmed with Lumbar MRI), were undergone urodynamic examination and perineal electromyography after surgical decompression action. These both assessments (urodynamic study and electromyography) were repeated during the follow-up of 15 patients in the first and sixth months after surgery and findings were compared with each other.Results:Among the Urodynamic findings, Qmax (maximum urine flow) during three studies had a significant relationship with long-term recovery rate of patients (P <0.05). The relationship had been more valuable in follow-ups after one month (P = 0.0001). Also, BCI (Bladder Contractility Index) in all three studies had a significant relationship with clinical improvement in the ability to urinate (P <0.001). The residual urine (PVR) compared to two previous urodynamic findings showed a less significant relationship with clinical cure rate (P = 0.04). Among the findings of muscle-nerve (MUAP Fibrillation, Positive sharp way) none of them had a significant relationship with cure rate.Conclusion:Urodynamic finding, especially Qmax and bladder contractility index, can be considered as predictive indicators for patients’ recovery after surgery.

Is there a relationship between prescribed medications and symptoms of cauda equina syndrome in patients with evidence of degenerative change in the lumbar spine?

Is there a relationship between prescribed medications and symptoms of cauda equina syndrome in patients with evidence of degenerative change in the lumbar spine?

Is there a relationship between prescribed medications and symptoms of cauda equina syndrome in patients with evidence of degenerative change in the lumbar spine?

Is there a relationship between prescribed medications and symptoms of cauda equina syndrome in patients with evidence of degenerative change in the lumbar spine?