Welcome to Francis Academic Press

Frontiers in Medical Science Research, 2024, 6(8); doi: 10.25236/FMSR.2024.060807.

Uncovering Cauda Equina Syndrome: An In-depth Analysis from a Cutting-Edge Medical Perspective

Author(s)

Mengyuan Wen1,2, Qiushi Wang3, Xiaojuan Shi1, Xiaolan Guo2

Corresponding Author:
Xiaolan Guo
Affiliation(s)

1Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi’an, China

2Shaanxi University of Chinese Medicine, Xianyang, China

3Department of Orthopaedic, Chinese PLA 970 Hospital, Yantai, China

Abstract

Cauda equina syndrome is a rare condition caused by compression of the cauda equina nerve roots. Although its definition remains somewhat inconsistent, typical clinical manifestations include varying degrees of sensory loss, motor weakness, and bowel and bladder dysfunction. There is currently no definitive diagnostic method; clinicians primarily rely on thorough medical history collection and physical examination, complemented by advanced imaging techniques such as MRI and CT, to determine the location and extent of nerve root compression. Suspected cases necessitate urgent spinal surgical intervention and decompression. Even with emergency surgery, the prognosis remains less than ideal. Given the complexity of this syndrome and its potential legal ramifications, clinicians must acquire a deep understanding of its clinical characteristics, diagnostic approaches, and treatment strategies. Through effective communication, standardized medical practices, comprehensive medical record-keeping, and efficient care, patient long-term outcomes can be optimized and the risk of litigation due to medical malpractice minimized.

Keywords

Cauda equina syndrome; clinical presentation; risk factors; prognosis; review

Cite This Paper

Mengyuan Wen, Qiushi Wang, Xiaojuan Shi, Xiaolan Guo. Uncovering Cauda Equina Syndrome: An In-depth Analysis from a Cutting-Edge Medical Perspective. Frontiers in Medical Science Research (2024), Vol. 6, Issue 8: 47-53. https://doi.org/10.25236/FMSR.2024.060807.

References

[1] Barker T P, Steele N, Swamy G, et al. Long-term core outcomes in cauda equina syndrome.[J]. The bone & joint journal,2021,103-B(9):1464-1471.

[2] Greenhalgh S, Finucane L, Mercer C, et al. Assessment and management of cauda equina syndrome.[J]. Musculoskeletal science & practice,2018,37:69-74.

[3] Woodfield J, Lammy S, Jamjoom A A B, et al. Demographics of Cauda Equina Syndrome: A Population-Based Incidence Study.[J]. Neuroepidemiology,2022,56(6):460-468.

[4] Budtz C R, Hansen R P, Thomsen J N L, et al. The prevalence of serious pathology in musculoskeletal physiotherapy patients - a nationwide register-based cohort study.[J]. Physiotherapy, 2021,112:96-102.

[5] Kuris E O, Mcdonald C L, Palumbo M A, et al. Evaluation and Management of Cauda Equina Syndrome[J]. The American Journal of Medicine,2021,134(12):1483-1489.

[6] W W Parke K G R H. Arterial vascularization of the cauda equina[J]. J Bone Joint Surg Am,1981,1(63):53-62.

[7] Mixter W J, Barr J S. Rupture of the Intervertebral Disc with Involvement of the Spinal Canal[J]. New England Journal of Medicine.1934.210-215.

[8] Lavy C, Marks P, Dangas K, et al. Cauda equina syndrome-a practical guide to definition and classification.[J]. International orthopaedics,2022,46(2):165-169.

[9] Germon T, Ahuja S, Casey A T H, et al. British Association of Spine Surgeons standards of care for cauda equina syndrome[J]. The Spine Journal,2015,15(3, Supplement):S2-S4.

[10] Surgeons B A O S. Standards of Care for Suspected and Confirmed Compressive Cauda Equina Syndrome[S]. 2009.

[11] Korse N S, Veldman A B, Peul W C, et al. The long term outcome of micturition, defecation and sexual function after spinal surgery for cauda equina syndrome.[J]. PloS one,2017,12(4):e0175987.

[12] Petrasic J R, Chhabra A, Scott K M. Impact of MR Neurography in Patients with Chronic Cauda Equina Syndrome Presenting as Chronic Pelvic Pain and Dysfunction.[J]. AJNR. American journal of neuroradiology,2017,38(2):418-422.

[13] Hoeritzauer I, Paterson M, Jamjoom A A B, et al. Cauda equina syndrome.[J]. The bone & joint journal,2023,105-B(9):1007-1012.

[14] Fraser S, Roberts L, Murphy E. Cauda Equina Syndrome: A Literature Review of Its Definition and Clinical Presentation[J]. Archives of Physical Medicine and Rehabilitation, 2009, 90(11):1964-1968.

[15] Comer C, Finucane L, Mercer C, et al. SHADES of grey - The challenge of 'grumbling' cauda equina symptoms in older adults with lumbar spinal stenosis.[J]. Musculoskeletal science & practice, 2020,45:102049.

[16] Metcalfe D, Hoeritzauer I, Angus M, et al. Diagnosis of cauda equina syndrome in the emergency department.[J]. Emergency medicine journal : EMJ,2023,40(11):787-793.

[17] Spector L R, Madigan L, Rhyne A, et al. Cauda equina syndrome.[J]. The Journal of the American Academy of Orthopaedic Surgeons,2008,16(8):471-479.

[18] Sun J, Xu T, Chen K, et al. Assessment of cauda equina syndrome progression pattern to improve diagnosis.[J]. Spine,2014,39(7):596-602.

[19] Barraclough K. Cauda equina syndrome[J]. BMJ,2021:n32.

[20] Gardner A, Gardner E, Morley T. Cauda equina syndrome: a review of the current clinical and medico-legal position.[J]. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society,2011,20(5):690-697.

[21] Goodman B P. Disorders of the Cauda Equina.[J]. Continuum (Minneapolis, Minn.),2018,24(2, Spinal Cord Disorders):584-602.

[22] Korse N S, Jacobs W C H, Elzevier H W, et al. Complaints of micturition, defecation and sexual function in cauda equina syndrome due to lumbar disk herniation: a systematic review.[J]. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society,2013,22(5):1019-1029.

[23] Mangialardi R, Mastorillo G, Minoia L, et al. Lumbar disc herniation and cauda equina syndrome. Considerations on a pathology with different clinical manifestations.[J]. La Chirurgia degli organi di movimento,2002,87(1):35-42.

[24] Mccarthy M J H, Aylott C E W, Grevitt M P, et al. Cauda equina syndrome: factors affecting long-term functional and sphincteric outcome.[J]. Spine,2007,32(2):207-216.

[25] Fuso F A F, Dias A L N, Letaif O B, et al. Epidemiological study of cauda equina syndrome.[J]. Acta ortopedica brasileira,2013,21(3):159-162.

[26] Bulloch L, Thompson K, Spector L. Cauda Equina Syndrome.[J]. The Orthopedic clinics of North America,2022,53(2):247-254.

[27] Wang Q, Wen M, Hou G, et al. Chronic cauda equina syndrome decompression surgery recovery is very "bad"? Based on patient self-assessment.[J]. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society,2023.

[28] Rider L S, Marra E M. Cauda Equina and Conus Medullaris Syndromes[J]. 2023.

[29] Greenhalgh S, Truman C, Webster V, et al. Development of a toolkit for early identification of cauda equina syndrome.[J]. Primary health care research & development,2016,17(6):559-567.

[30] Kennedy J G, Soffe K E, Mcgrath A, et al. Predictors of outcome in cauda equina syndrome.[J]. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 1999, 8(4):317-322.

[31] Tabrah J, Wilson N, Phillips D, et al. Can digital rectal examination be used to detect cauda equina compression in people presenting with acute cauda equina syndrome? A systematic review and meta-analysis of diagnostic test accuracy studies.[J]. Musculoskeletal science & practice, 2022,58:102523.

[32] Coscia M, Leipzig T, Cooper D. Acute cauda equina syndrome. Diagnostic advantage of MRI.[J]. Spine,1994,19(4):475-478.

[33] Yamanaka Y, Kamogawa J, Katagi R, et al. 3-D MRI/CT fusion imaging of the lumbar spine.[J]. Skeletal radiology,2010,39(3):285-288.

[34] Todd N V. Cauda equina syndrome: is the current management of patients presenting to district general hospitals fit for purpose? A personal view based on a review of the literature and a medicolegal experience.[J]. The bone & joint journal,2015,97-B(10):1390-1394.

[35] Mallepally A R, Mohapatra B, Das K. Role of Invasive Urodynamic Studies in Establishing Cauda Equina Syndrome and Postoperative Recovery.[J]. Global spine journal,2022,12(7):1352-1362.

[36] Hellström P, Kortelainen P, Kontturi M. Late urodynamic findings after surgery for cauda equina syndrome caused by a prolapsed lumbar intervertebral disk.[J]. The Journal of urology, 1986,135(2):308-312.

[37] Todd N V. Bladder ultrasonography in the assessment of cauda equina syndrome in the emergency department: a literature review.[J]. Annals of the Royal College of Surgeons of England,2024,106(1):9-12.

[38] Long B, Koyfman A, Gottlieb M. The role of bladder volume for diagnosing cauda equina syndrome.[J]. The American journal of emergency medicine,2021,48:336-337.

[39] Todd N, Dangas K, Lavy C. Post-void bladder ultrasound in suspected cauda equina syndrome-data from medicolegal cases and relevance to magnetic resonance imaging scanning.[J]. International orthopaedics,2022,46(6):1375-1380.

[40] Richardson G E, Millward C P, Mitchell J W, et al. Identification and Assessment of Outcome Measurement Instruments in Cauda Equina Syndrome: A Systematic Review.[J]. Global spine journal,2024:1250800500.

[41] Hazelwood J E, Hoeritzauer I, Pronin S, et al. An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome.[J]. Acta neurochirurgica, 2019, 161(9):1887-1894.

[42] Jha V, Deep G, Pandita N, et al. Factors affecting urinary outcome after delayed decompression in complete cauda equina syndrome: “A regression model study”[J]. European Journal of Trauma and Emergency Surgery,2022,48(2):1009-1016.

[43] Hazelwood J E, Hoeritzauer I, Carson A, et al. Long-term mental wellbeing and functioning after surgery for cauda equina syndrome.[J]. PloS one,2021,16(8):e0255530.

[44] Corso K A, Joo P, Ruppenkamp J, et al. Racial and Health Insurance Differences in Patient Outcomes After Surgical Treatment for Cauda Equina Syndrome: A United States Retrospective Hospital Claims Database Analysis.[J]. Spine,2023,48(19):1373-1387.

[45] Qureshi A, Sell P. Cauda equina syndrome treated by surgical decompression: the influence of timing on surgical outcome.[J]. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society,2007,16(12):2143-2151.

[46] Todd N V, Dickson R A. Standards of care in cauda equina syndrome.[J]. British journal of neurosurgery,2016,30(5):518-522.

[47] Ruan W, Feng F, Liu Z, et al. Comparison of percutaneous endoscopic lumbar discectomy versus open lumbar microdiscectomy for lumbar disc herniation: A meta-analysis.[J]. International journal of surgery (London, England),2016,31:86-92.

[48] Choi K, Lee D C, Shim H, et al. A Strategy of Percutaneous Endoscopic Lumbar Discectomy for Migrated Disc Herniation.[J]. World neurosurgery,2017,99:259-266.

[49] Byvaltsev V A, Kalinin A A, Shepelev V V, et al. Minimally Invasive Tlif Compared To Open Tlif For Acute Cauda Equina Syndrome: A Retrospective Single Center Study With Long-Term Follow-Up.[J]. World neurosurgery,2022.

[50] Yankang L, Leiming Z, Lewandrowski K, et al. Full Endoscopic Lumbar Discectomy Versus Laminectomy for Cauda Equina Syndrome.[J]. International journal of spine surgery, 2021,15(1):105-112.

[51] Rascón-Ramírez F J. Spinal cord stimulation and cauda equina syndrome: Could it be a valid option? A report of two cases.[J]. Neurocirugia (English Edition),2022,33(2):90-94.

[52] Ahn U M, Ahn N U, Buchowski J M, et al. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes.[J]. Spine,2000,25(12):1515-1522.

[53] Delamarter R B, Sherman J E, Carr J B. 1991 Volvo Award in experimental studies. Cauda equina syndrome: neurologic recovery following immediate, early, or late decompression.[J]. Spine,1991,16(9):1022-1029.

[54] Kumar V, Baburaj V, Rajnish R K, et al. Outcomes of cauda equina syndrome due to lumbar disc herniation after surgical management and the factors affecting it: a systematic review and meta-analysis of 22 studies with 852 cases.[J]. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society,2022,31(2):353-363.

[55] Pronin S, Hoeritzauer I, Statham P F, et al. Are we neglecting sexual function assessment in suspected cauda equina syndrome?[J]. The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland,2020,18(1):8-11.

[56] Butenschoen V M, Abulhala S, Meyer B, et al. Body mass index has an impact on preoperative symptoms but not clinical outcome in acute cauda equina syndrome.[J]. Scientific reports, 2021,11(1):13918.

[57] Wang Q, Hou G, Wen M, et al. How to assess the long-term recovery outcomes of patients with cauda equina  syndrome before surgery: a retrospective cohort study[J]. Int J Surg, 2024, 110(7):4197-4207.