CAUDA EQUinA – BACkgROUnD
The complete syndrome is
characterised by painless
urinary retention with overflow
incontinence (CES-Retention),
when the bladder is no longer
under executive control. There
is usually extensive or complete
saddle and genital sensory deficit.
The outcome for patients with
CES-I at the time of surgery is
generally favourable, whereas
those who have deteriorated to
CES-R when the compression is
relieved have a poorer prognosis,
although around 70% of CES-R
patients had a socially acceptable
long term outcome.
21
LBP and sciatica are of course
common, but bilateral neurogenic
sciatica, especially with
neurological signs, should always
ring alarm bells. Its occurrence with
any of the above so-called ‘red flag’
symptoms must trigger immediate
action involving emergency referral
to an Accident and Emergency
Department with ready access to
a Spinal Surgery Unit, preferably
accompanied by an explanatory
telephone call to reduce delays.
The diagnosis is confirmed by
prompt MR scanning.
10
surgical treatment, so it has proved • The prognostic significance
Cauda equina syndrome is a very difficult to carry out high of unilateral and bilateral leg
relatively rare condition, comprising quality prospective studies with signs.
around 2-3% of lumbar disc statistical power sufficient to draw • The medico-legal implications
operations.
11,12
Chang et al. found firm conclusions concerning the of the above.
four patients presenting with principal contentious issues. These
classic CES (2.8%) in a series are: Since complex human interactions
of 144 consecutive cases with • The significance of delays are involved in the management
lumbar disc prolapse undergoing in diagnosis and referral to of this sometimes ill-defined and
surgery.
43
The incidence in the hospital. variable condition, dogmatic
general population is thought to • The risks and benefits of statements are unwise.
be between 1 in 33,000 to 1 in emergency versus urgent
100,000.
13
It may be that most UK surgery. The analysis of all the variables in
general practitioners are unlikely to • The significance of surgical CES may be simplified in view of
see one true case of CES caused delay beyond 24 and 48 hours. the fact that the most regrettable
by intervertebral disc herniation in • The prognostic significance of and damaging consequence of
their entire career.
57
complete versus incomplete cauda equina compression is
sphincter involvement and bladder dysfunction. The terms
Cauda equina syndrome generally complete versus incomplete CES-I and CES-R as described
requires urgent or emergency sensory deficit. above denote useful and usually
The Backcare Journal 33
backcare Winter 2009/10.indd 33 8/1/10 11:20:14
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