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
| Autor: | N. V. Todd |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
Nerve root Cauda equina syndrome Hospitals General Emergency surgery medicine Humans Orthopedics and Sports Medicine Polyradiculopathy medicine.diagnostic_test business.industry General surgery Cauda equina Magnetic resonance imaging Rectal examination medicine.disease Hospitals District Magnetic Resonance Imaging Surgery medicine.anatomical_structure View based Treatment Outcome Current management Practice Guidelines as Topic business |
| Zdroj: | The bonejoint journal. (10) |
| ISSN: | 2049-4408 |
| Popis: | There is no universally agreed definition of cauda equina syndrome (CES). Clinical signs of CES including direct rectal examination (DRE) do not reliably correlate with cauda equina (CE) compression on MRI. Clinical assessment only becomes reliable if there are symptoms/signs of late, often irreversible, CES. The only reliable way of including or excluding CES is to perform MRI on all patients with suspected CES. If the diagnosis is being considered, MRI should ideally be performed locally in the District General Hospitals within one hour of the question being raised irrespective of the hour or the day. Patients with symptoms and signs of CES and MRI confirmed CE compression should be referred to the local spinal service for emergency surgery. CES can be subdivided by the degree of neurological deficit (bilateral radiculopathy, incomplete CES or CES with retention of urine) and also by time to surgical treatment (12, 24, 48 or 72 hour). There is increasing understanding that damage to the cauda equina nerve roots occurs in a continuous and progressive fashion which implies that there are no safe time or deficit thresholds. Neurological deterioration can occur rapidly and is often associated with longterm poor outcomes. It is not possible to predict which patients with a large central disc prolapse compressing the CE nerve roots are going to deteriorate neurologically nor how rapidly. Consensus guidelines from the Society of British Neurological Surgeons and British Association of Spinal Surgeons recommend decompressive surgery as soon as practically possible which for many patients will be urgent/emergency surgery at any hour of the day or night. Cite this article: Bone Joint J 2015;97-B:1390–4 |
| Databáze: | OpenAIRE |
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