scholarly journals P31 Cauda equina syndrome – the importance of an early, accurate diagnosis and treatment in preventing bladder dysfunction

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Victoria Amy Porter ◽  
Victoria Porter
Keyword(s):  
Urinary Retention ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Accurate Diagnosis ◽  
Diagnostic Methods ◽  
Diagnosis And Treatment ◽  
Decompressive Surgery ◽  
Bladder Function ◽  
Urological Complications ◽  
Significant Difference

Abstract Introduction Cauda Equina Syndrome (CES), is a neurological emergency with many urological features. Delayed decompressive surgery can cause urinary retention, overflow incontinence, long term catherization and loss of sexual function. This article focusses on the accuracy of the initial diagnosis and the time taken before treatment is commenced. Methods In this systematic literature review, OneSearch and PubMed have been searched for articles which identify the main symptoms of CES, evaluate the effectiveness of several diagnostic methods and compare the postoperative results of bladder function following timely and delayed treatment. Results A total of 20 articles have been referenced, of which 9 studies have been reviewed. While no individual symptom is 100% indicative of CES, urinary retention (diagnostic accuracy 0.9), is the most consistent clinical finding. Therefore, MRI is necessary for an accurate diagnosis. Further 4 out of 5 studies state that treatment within 24-hours improves patient outcomes compared to 48-hours, one study showed no significant difference between 24 and 48 hours. All articles indicate beyond 48-hours, surgical intervention has little impact on the relief of symptoms. Conclusion The studies concluded that any patient presenting in the emergency department with lower back pain should be screened for CES. A thorough history and neurological examination should be performed; however, the evidence base for rectal examination to assess anal tone is poor. Decompressive surgery carried out within the first 24-hour period from the onset of symptoms is favourable. Overall, early accurate diagnosis and treatment is invaluable to preventing urological complications and improving prognosis.

scholarly journals The role of surgical decompression of Cauda equina in lumbar disc herniation in recovery of bladder function

2004 ◽  
Vol 57 (7-8) ◽  
pp. 327-330 ◽  
Author(s):  
Danilo Radulovic ◽  
Goran Tasic ◽  
Milos Jokovic ◽  
Igor Nikolic
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Surgical Decompression ◽  
Bladder Function ◽  
Duration Of Symptoms ◽  
Significant Difference

INTRODUCTION Cauda equina syndrome from lumbar disc herniation accounts for up to 2-3% of all disc herniations. The aim of this study was to investigate whether recovery of bladder function after surgery depends on preoperative duration of disease. Patients and methods This retrospective study included 47 patients who underwent surgery for cauda equina syndrome due to a herniated disc in the period between 1997 and 2002. Eleven patients were female and 36 male, with a mean age of 43 years (range 23-67). All presented with sciatica and saddle hypoesthesia, whereas 13 presented with motor weakness of legs. All patients had been catheterized at the time of admission to the Neurosurgical unit. Levels of herniation were L4-L5 in 27 (57%), L5-S1 in 14 (30%), and L3-L4 in 6 (13%) patients. In 7 (15%) patients, surgery was performed within 48 hours of the cauda equina syndrome onset. None underwent surgery within 24 hours. 13 (28%) patients were operated between the 2nd and 7th day and 27 (57%) after 7th day of the cauda equina onset. The role of preoperative duration of symptoms in recovery of bladder function was examined (chi 2 analysis). RESULTS The follow-up ranged from 15 to 74 months (mean 24.2 months). In 33 patients (70%) excellent result were achieved, in 9 (19%) patients good results and 5 (11%) patients presented with poor results. There was no statistically significant difference concerning the time between the onset of symptoms and surgical decompression and subsequent recovery of bladder function (p>0.05). CONCLUSION After accurate diagnosis and adequate operative treatment, postoperative results of cauda equina syndrome due to lumbar disc herniation appear satisfactory regardless of the timing of surgery.

178 Suspected Cauda Equina Syndrome in a District General Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Ellerton ◽  
H Benjamin-Laing ◽  
W J Harrison
Keyword(s):  
General Hospital ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
District General Hospital ◽  
Bladder Function ◽  
Mri Scan ◽  
Eligibility Criteria ◽  
Joint Project ◽  
Tertiary Centre ◽  
Patient Morbidity

Abstract Introduction Cauda Equina Syndrome (CES) is rare but when the diagnosis is delayed patient morbidity is significant. Recently, NICE Clinical Knowledge Summaries have updated their red flags on CES to be more explicit enabling earlier referral and diagnosis. A joint project between Orthopaedics and Radiology departments aimed to assess the current pathway of Cauda Equina Investigation at a District General Hospital. Method Data was collected from the local Radiology database for requests between July 2017 and August 2018. This included both direct requests to assess for CES and implied. Raw data revealed a potential of 600 patients, of which we have analysed 332 patients met the eligibility criteria. Results Only 58 patients had a documented complete bladder function assessment, of those 33% had incomplete or partial bladder emptying. Time to MRI scan ranged from 50mins – 23 hours & 52 mins. 47% had negative scans with CES or Cord compromise on MRI scan was demonstrated on 9%. 23 patients were transferred urgently to the receiving tertiary centre. Conclusions We found that nearly 90% of patients were being incompletely assessed and time to scan ranged significantly. We are producing a trust wide suspected CES pathway to improve patient assessment.

Do safety-net hospitals provide equitable care after decompressive surgery for acute cauda equina syndrome?

2021 ◽  
Vol 200 ◽  
pp. 106356
Author(s):  
Archis R. Bhandarkar ◽  
Mohammed Ali Alvi ◽  
James M. Naessens ◽  
Mohamad Bydon
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Safety Net ◽  
Decompressive Surgery

scholarly journals Dorsal extrusion of intervertebral disc as a cause of cauda equina syndrome

2011 ◽  
Vol 64 (7-8) ◽  
pp. 419-421
Author(s):  
Aldin Jusic ◽  
Rasim Skomorac ◽  
Hakija Beculic
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Intervertebral Disc ◽  
Urinary Retention ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Good Recovery ◽  
Resonance Imaging ◽  
Extradural Space

We have presented a case of rare dorsally sequestrated lumbar disc herniation manifesting as cauda equina syndrome. The patient was admitted to the Neurological Department of Canton Hospital Zenica due to urinary retention and weakness in both lower extremities. Magnetic resonance imaging showed a compressing mass located in the dorsal extradural space at the L2- L3 level. An extruded intervertebral disc was found intraoperatively. The decompression was followed by good recovery.

scholarly journals Clinical Significance of Molecular Diagnostic Tools for Bacterial Bloodstream Infections: A Systematic Review

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Jean Pierre Rutanga ◽  
Therese Nyirahabimana
Keyword(s):  
Systematic Review ◽  
Antibiotic Therapy ◽  
Clinical Significance ◽  
Molecular Diagnosis ◽  
Accurate Diagnosis ◽  
Molecular Techniques ◽  
Diagnostic Methods ◽  
Diagnosis And Treatment ◽  
Molecular Diagnostic ◽  
Diagnostic Tools

Bacterial bloodstream infection (bBSI) represents any form of invasiveness of the blood circulatory system caused by bacteria and can lead to death among critically ill patients. Thus, there is a need for rapid and accurate diagnosis and treatment of patients with septicemia. So far, different molecular diagnostic tools have been developed. The majority of these tools focus on amplification based techniques such as polymerase chain reaction (PCR) which allows the detection of nucleic acids (both DNA and small RNAs) that are specific to bacterial species and sequencing or nucleic acid hybridization that allows the detection of bacteria in order to reduce delay of appropriate antibiotic therapy. However, there is still a need to improve sensitivity of most molecular techniques to enhance their accuracy and allow exact and on time antibiotic therapy treatment. In this regard, we conducted a systematic review of the existing studies conducted in molecular diagnosis of bBSIs, with the main aim of reporting on clinical significance and benefits of molecular diagnosis to patients. We searched both Google Scholar and PubMed. In total, eighteen reviewed papers indicate that shift from conventional diagnostic methods to molecular tools is needed and would lead to accurate diagnosis and treatment of bBSI.

scholarly journals Resolution of cauda equina syndrome after surgical extraction of lumbar intrathecal bullet

2020 ◽  
Vol 11 ◽  
pp. 214
Author(s):  
Zaid Aljuboori ◽  
Emily Sieg
Keyword(s):  
Lower Extremity ◽  
Urinary Retention ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Spinal Column ◽  
Neurological Damage ◽  
Burning Pain ◽  
Extensor Hallucis Longus ◽  
Surgical Extraction ◽  
The Right

Background: Gunshot wound (GSW) injuries to the spinal column are correlated with potentially severe neurological damage. Here, we describe a GSW to the thoracolumbar junction (e.g., T12/L1 level) which resulted in a cauda equina syndrome that resolved once the bullet was removed. Case Description: A 29-year-old male presented with a T12-L1 GSW; the bullet traversed the right chest and liver, entered the spinal canal at T12, and then settled at L1. He experienced excruciating burning pain in the right lower extremity/perineum and had urinary retention. On neurological examination, he exhibited severe weakness of the right iliopsoas/quadriceps (2/5) and extensor hallucis longus (1/5) which had decreased sensation in the right lower extremity in all dermatomes and urinary retention. The myelogram showed the bullet lodged intrathecally at L1; it compressed the cauda equina. Immediately after, the bullet was extracted and at 8 weeks follow-up, the patient’s right-sided motor function normalized, the sensory findings improved, and the sphincteric dysfunction resolved; the only residual deficit was minimal residual numbness in the L2-L5 distributions. Conclusion: Twenty percent of penetrating spinal column injuries are attributed to GSW s. The location of these injuries best determines the neurological damage and degree of recovery. Since patients with incomplete cauda equina syndromes have favorable prognoses, removal of bullets involving the T12-S1 levels may prove beneficial.

scholarly journals Electroacupuncture for Bladder Function Recovery in Patients Undergoing Spinal Anesthesia

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Yinqiu Gao ◽  
Xinyao Zhou ◽  
Xichen Dong ◽  
Qing Jia ◽  
Shen Xie ◽  
...  
Keyword(s):  
Adverse Events ◽  
Spinal Anesthesia ◽  
Urinary Retention ◽  
Urine Volume ◽  
Bladder Function ◽  
Control Group ◽  
Postoperative Urinary Retention ◽  
Function Recovery ◽  
Significant Difference ◽  
Secondary Endpoints

Purpose. To determine the efficacy of electroacupuncture on recovering postanesthetic bladder function.Materials and Methods. Sixty-one patients undergoing spinal anaesthesia were recruited and allocated into electroacupuncture or control group randomly. Patients in electroacupuncture group received electroacupuncture therapy whereas ones in control group were not given any intervention. Primary endpoint was incidence of bladder overdistension and postoperative urinary retention. Secondary endpoints included time to spontaneous micturition, voided volume, and adverse events.Results. All patients (31 in electroacupuncture group and 30 in control group) completed the evaluation. During postoperative follow-up, patients in electroacupuncture group presented a significant lower proportion of bladder overdistension than counterparts in control group (16.1% versus 53.3%,P< 0.01). However, no significant difference was found in incidence of postoperative urinary retention between the two groups (0% versus 6.7%,P> 0.05). Furthermore, a shorter time to spontaneous micturition was found in electroacupuncture group compared to control group (228 min versus 313 min,P< 0.001), whereas urine volume and adverse events had no significant difference between the two groups.Conclusions. Electroacupuncture reduced the proportion of bladder overdistension and shortened the time to spontaneous micturition in patients undergoing spinal anesthesia. Electroacupuncture may be a therapeutic strategy for postanesthetic bladder dysfunction.

scholarly journals Evaluation of Outcome of Timing of Surgical Intervention on Cauda Equina Syndrome

2021 ◽  
Vol 20 (1) ◽  
pp. 19-23
Author(s):  
Rajesh Pratap Shah ◽  
Bishnu Babu Thapa ◽  
Sushil Rana Magar ◽  
Ritesh Sinha ◽  
Pankaj Chand ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Tertiary Care ◽  
Cauda Equina ◽  
Timing Of Surgery ◽  
Bladder Function ◽  
Delayed Presentation ◽  
Inclusion Criteria ◽  
Permanent Disability ◽  
Number Of Patients

Introduction: Cauda equina syndrome (CES) is a rare clinical entity caused by compression of lumbar and sacral nerve roots resulting in various neurological dysfunctions. Early diagnosis of the syndrome and timely intervention is required to prevent permanent disability. Methods: This is a retrospective study conducted from January 2013 to December 2017 in a tertiary care centre in Kathmandu, Nepal. All the cases meeting the inclusion criteria were included in the study. Patients were operated using posterior open discectomy and the outcome was evaluated at  two weeks , one month, three months, six months and one year. Result: Total number of patients meeting the inclusion criteria was 10, two females and eight males with a mean age of 40.30 + 6.58 years. The mean time for onset of symptom to timing of surgery was 142 hrs. VAS for leg improved from 5.90 + 0 .738 to 0.70 + 0.483 and VAS for back pain improved from 3.20 + 1.476 to 0.5 + 0.572 post operatively. There was improvement in sensory and motor function in all the cases. Bowel and bladder function improved in all the cases postoperatively at the time of final follow up. Sexual function was impaired in six patients preoperatively but postoperatively four had improved and two patients had poor result at the time of final follow up. Conclusions: Timing of surgery may not be the most important determining factor for the outcome of the CES. Surgical decompression in delayed presentation have good clinical outcome in CES.

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