The Lancet Regional Health. Europe (Jan 2023)

Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: A multi-centre prospective cohort studyResearch in context

  • Julie Woodfield,
  • Ingrid Hoeritzauer,
  • Aimun A.B. Jamjoom,
  • Josephine Jung,
  • Simon Lammy,
  • Savva Pronin,
  • Cathal J. Hannan,
  • Anna Watts,
  • Laura Hughes,
  • Richard D.C. Moon,
  • Stacey Darwish,
  • Holly Roy,
  • Phillip C. Copley,
  • Michael T.C. Poon,
  • Paul Thorpe,
  • Nisaharan Srikandarajah,
  • Gordan Grahovac,
  • Andreas K. Demetriades,
  • Niall Eames,
  • Philip J. Sell,
  • Patrick F.X. Statham,
  • Mohamed Abdelsadg,
  • Motaz MS Abulaila,
  • Usman Ahmed,
  • Qasim Ajmi,
  • Rafid Al-Mahfoudh,
  • Chadi Ali,
  • Meriem Amarouche,
  • Amin Andalib,
  • Mohit Arora,
  • Mukul Arora,
  • Mariam Awan,
  • Afsand Baig Mirza,
  • Antony Bateman,
  • Iwan Bennett,
  • Imran Bhatti,
  • Peter Bodkin,
  • Lalasa Bommireddy,
  • George Bonanos,
  • Anouk Borg,
  • Alexandros Boukas,
  • James Bourne,
  • Rachael Brennan,
  • Jennifer Brown,
  • Katie Brown,
  • Oliver Burton,
  • Christopher Busby,
  • Neil Chiverton,
  • Simon Clark,
  • Phillip C Copley,
  • Simon Cudlip,
  • Yan Cunningham,
  • Ronan Dardis,
  • Stacey Darwish,
  • Benjamin Davies,
  • Andreas K Demetriades,
  • Saurabh Deore,
  • Chris Derham,
  • Muhammad Dherijha,
  • Gareth Dobson,
  • James Duncan,
  • Andrew Durnford,
  • Alexander ZE Durst,
  • Edward W Dyson,
  • Niall Eames,
  • Ellie Edlmann,
  • Andrew Edwards-Bailey,
  • Anne Elserius,
  • Becca Elson,
  • Mohammed Fadelalla,
  • Daniel M Fountain,
  • Adrian Gardner,
  • Arnab Ghosh,
  • James R Gill,
  • Stella A Glasmacher,
  • Robin Gordon,
  • Gordan Grahovac,
  • Rebecca Grenfell,
  • Awais Habeebullah,
  • Nikolaos Haliasos,
  • Tim Hammett,
  • Cathal John Hannan,
  • Ciaran Scott Hill,
  • Ingrid Hoeritzauer,
  • David Holmes,
  • Kismet Hossain-Ibrahim,
  • Laura Hughes,
  • Muhammad Hussain,
  • Shakir Hussain,
  • Ramez Ibrahim,
  • Aimun AB Jamjoom,
  • Bethan John,
  • Shabin Joshi,
  • Josephine Jung,
  • Oliver Kennion,
  • Muhammad Khan,
  • Adriana Klejnotowska,
  • Ashwin Kumaria,
  • Roberta LaCava,
  • Simon Lammy,
  • Alistair Lawrence,
  • Matthew Lea,
  • Andraay HC Leung,
  • Ignatius Liew,
  • Weisang Luo,
  • Oscar MacCormac,
  • James Manfield,
  • Richard Mannion,
  • Joseph Merola,
  • Pranav Mishra,
  • Khalid Abubaker Mohmoud,
  • Richard Moon,
  • Rory Morrison,
  • Odhran Murray,
  • Ali Nader-Sepahi,
  • Colin Nnandi,
  • Anand Pandit,
  • Nitin Patel,
  • Anita Philip,
  • Michael TC Poon,
  • Kuskoor Seethram Manjunath Prasad,
  • Savva Pronin,
  • Shyam Pujara,
  • Balaji Purushothaman,
  • Kapil Rajwani,
  • Fahid Tariq Rasul,
  • Holly Roy,
  • Ahmed-Ramadan Sadek,
  • Moritz Schramm,
  • Gabrielle Scicluna,
  • Philip J Sell,
  • Roozbeh Shafafy,
  • Himanshu Sharma,
  • Asim Sheikh,
  • Vinothan Sivasubramaniam,
  • Agbolahan Sofela,
  • George Spink,
  • Nisaharan Srikandarajah,
  • Patrick FX Statham,
  • Stuart Stokes,
  • Euan Strachan,
  • Chrishan Thakar,
  • Gopiga Thanabalasundaram,
  • Paul Thorpe,
  • Christian Ulbricht,
  • Anna Watts,
  • Alison Whitcher,
  • David White,
  • Kathrin Whitehouse,
  • Martin Wilby,
  • Julie Woodfield,
  • Ardalan Zolnourian

Journal volume & issue
Vol. 24
p. 100545

Abstract

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Summary: Background: Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods: This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings: In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Interpretation: Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding: DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.

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