Daniel M Fountain1, Simon C L Davies2, Julie Woodfield3,4, Mohammed Kamel5, Paulina Majewska6, Ellie Edlmann1, Aimun A B Jamjoom4, Ingrid Hoeritzauer4,7, Mueez Waqar8, Dominic E Mahoney9, Dillon Vyas10, Moritz W J Schramm11, Georgios Solomou12, Francesca E C Dawkes13, Heidi K Grant14, Jonathan E Attwood15, Alexandros Boukas15, Dominic J Ballard16, Emma Toman17, Matthew I Sanders18, Beverly Cheserem19, Saurabh Sinha18, Patrick Statham4. 1. Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 2. Department of Neurosurgery, Barts Health NHS Trust, London, UK. 3. Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK. 4. Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK. 5. Department of Neurosurgery, Nottingham University Hospitals Foundation Trust, Nottingham, UK. 6. Department of Neurosurgery, Queen's Hospital, Romford, UK. 7. Centre for Clinical Brain Sciences, University of Edinburgh, UK. 8. Division of Academic Neurosurgery, Manchester, UK. 9. Bristol Medical School, University of Bristol, Bristol, UK. 10. School of Medicine, University of Leeds, Leeds, UK. 11. Department of Neurosurgery, Leeds General Infirmary, Leeds, UK. 12. Keele Medical School, Keele University, Keele, UK. 13. Leicester Medical School, University of Leicester, Leicester, UK. 14. Brighton and Sussex Medical School, Brighton, UK. 15. Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK. 16. Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK. 17. Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK. 18. Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, UK. 19. Department of Neurosurgery, Brighton and Sussex University Hospital, Brighton, UK.
Abstract
Purpose: Cauda equina syndrome (CES) is a spinal emergency with clinical symptoms and signs that have low diagnostic accuracy. National guidelines in the United Kingdom (UK) state that all patients should undergo an MRI prior to referral to specialist spinal units and surgery should be performed at the earliest opportunity. We aimed to evaluate the current practice of investigating and treating suspected CES in the UK. Materials and Methods: A retrospective, multicentre observational study of the investigation and management of patients with suspected CES was conducted across the UK, including all patients referred to a spinal unit over 6 months between 1st October 2016 and 31st March 2017. Results: A total of 28 UK spinal units submitted data on 4441 referrals. Over half of referrals were made without any previous imaging (n = 2572, 57.9%). Of all referrals, 695 underwent surgical decompression (15.6%). The majority of referrals were made out-of-hours (n = 2229/3517, 63.4%). Patient location and pre-referral imaging were not associated with time intervals from symptom onset or presentation to decompression. Patients investigated outside of the spinal unit experienced longer time intervals from referral to undergoing the MRI scan. Conclusions: This is the largest known study of the investigation and management of suspected CES. We found that the majority of referrals were made without adequate investigations. Most patients were referred out-of-hours and many were transferred for an MRI without subsequently requiring surgery. Adherence to guidelines would reduce the number of referrals to spinal services by 72% and reduce the number of patient transfers by 79%.
Purpose: Cauda equina syndrome (CES) is a spinal emergency with clinical symptoms and signs that have low diagnostic accuracy. National guidelines in the United Kingdom (UK) state that all patients should undergo an MRI prior to referral to specialist spinal units and surgery should be performed at the earliest opportunity. We aimed to evaluate the current practice of investigating and treating suspected CES in the UK. Materials and Methods: A retrospective, multicentre observational study of the investigation and management of patients with suspected CES was conducted across the UK, including all patients referred to a spinal unit over 6 months between 1st October 2016 and 31st March 2017. Results: A total of 28 UK spinal units submitted data on 4441 referrals. Over half of referrals were made without any previous imaging (n = 2572, 57.9%). Of all referrals, 695 underwent surgical decompression (15.6%). The majority of referrals were made out-of-hours (n = 2229/3517, 63.4%). Patient location and pre-referral imaging were not associated with time intervals from symptom onset or presentation to decompression. Patients investigated outside of the spinal unit experienced longer time intervals from referral to undergoing the MRI scan. Conclusions: This is the largest known study of the investigation and management of suspected CES. We found that the majority of referrals were made without adequate investigations. Most patients were referred out-of-hours and many were transferred for an MRI without subsequently requiring surgery. Adherence to guidelines would reduce the number of referrals to spinal services by 72% and reduce the number of patient transfers by 79%.
Authors: A Silva; B Sachdev; M Kostusiak; Mubarak Yousif; G Flint; J Dhir; N Furtado; R Laing Journal: Ann R Coll Surg Engl Date: 2021-03 Impact factor: 1.951
Authors: Nicola Newall; Brandon G Smith; Oliver Burton; Aswin Chari; Angelos G Kolias; Peter J Hutchinson; Alexander Alamri; Chris Uff Journal: World Neurosurg X Date: 2021-03-31