Cauda equina syndrome: a review of the current clinical and medico-legal position
- 31 December 2010
- journal article
- review article
- Published by Springer Science and Business Media LLC in European Spine Journal
- Vol. 20 (5), 690-697
- https://doi.org/10.1007/s00586-010-1668-3
Abstract
Cauda equina syndrome (CES) is a rare condition with a disproportionately high medico-legal profile. It occurs most frequently following a large central lumbar disc herniation, prolapse or sequestration. Review of the literature indicates that around 50–70% of patients have urinary retention (CES-R) on presentation with 30–50% having an incomplete syndrome (CES-I). The latter group, especially if the history is less than a few days, usually requires emergency MRI to confirm the diagnosis followed by prompt decompression by a suitably experienced surgeon. Every effort should be made to avoid CES-I with its more favourable prognosis becoming CES-R while under medical supervision either before or after admission to hospital. The degree of urgency of early surgery in CES-R is still not in clear focus but it cannot be doubted that earliest decompression removes the mechanical and perhaps chemical factors which are the causes of progressive neurological damage. A full explanation and consent procedure prior to surgery is essential in order to reduce the likelihood of misunderstanding and litigation in the event of a persistent neurological deficit.Keywords
This publication has 40 references indexed in Scilit:
- LetterJournal of Neurosurgery: Spine, 2009
- Authors' ResponseThe Annals of The Royal College of Surgeons of England, 2009
- The Value of Interhospital Transfer and Emergency MRI for Suspected Cauda Equina Syndrome: A 2-Year Retrospective StudyThe Annals of The Royal College of Surgeons of England, 2008
- Cauda equina syndrome treated by surgical decompression: the influence of timing on surgical outcomeEuropean Spine Journal, 2007
- Epidemiology of cauda equina and conus medullaris lesionsMuscle & Nerve, 2006
- CAUDA EQUINA SYNDROME SECONDARY TO CONSTIPATION: AN UNCOMMON OCCURRENCEAnz Journal of Surgery, 2005
- Lumbar herniated disc presenting with cauda equina syndrome: Long-term follow-up of four casesSurgical Neurology, 2000
- Fatores prognósticos do trauma raquimedular por projétil de arma de fogo em pacientes submetidos a laminectomiaArquivos de Neuro-Psiquiatria, 1999
- Predictors of outcome in cauda equina syndromeEuropean Spine Journal, 1999
- Acute Cauda Equina SyndromeSpine, 1994