| Title: |
Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study |
| Authors: |
Woodfield, J; Hoeritzauer, I; Jamjoom, AAB; Jung, J; Lammy, S; Pronin, S; Hannan, CJ; Watts, A; Hughes, L; Moon, RDC; Darwish, S; Roy, H; Copley, PC; Poon, MTC; Thorpe, P; Srikandarajah, N; Grahovac, G; Demetriades, AK; Eames, N; Sell, PJ; Statham, PFX; Abdelsadg, M; Abulaila, MMS; Ahmed, U; Ajmi, Q; Al-Mahfoudh, R; Ali, C; Amarouche, M; Andalib, A; Arora, M; Awan, M; Baig Mirza, A; Bateman, A; Bennett, I; Bhatti, I; Bodkin, P; Bommireddy, L; Bonanos, G; Borg, A; Boukas, A; Bourne, J; Brennan, R; Brown, J; Brown, K; Burton, O; Busby, C; Chiverton, N; Clark, S; Cudlip, S; Cunningham, Y; Dardis, R; Davies, B; Deore, S; Derham, C; Dherijha, M; Dobson, G; Duncan, J; Durnford, A; Durst, AZE; Dyson, EW; Edlmann, E; Edwards-Bailey, A; Elserius, A; Elson, B; Fadelalla, M; Fountain, DM; Gardner, A; Ghosh, A; Gill, JR; Glasmacher, SA; Gordon, R; Grenfell, R; Habeebullah, A; Haliasos, N; Hammett, T; Hill, CS; Holmes, D; Hossain-Ibrahim, K; Hussain, M; Hussain, S; Ibrahim, R; John, B; Joshi, S; Kennion, O; Khan, M; Klejnotowska, A; Kumaria, A; LaCava, R; Lawrence, A; Lea, M; Leung, AHC; Liew, I; Luo, W; MacCormac, O; Manfield, J; Mannion, R; Merola, J; Mishra, P; Mohmoud, KA; Moon, R; Morrison, R; Murray, O; Nader-Sepahi, A; Nnandi, C; Pandit, A; Patel, N; Philip, A; Prasad, KSM; Pujara, S; Purushothaman, B; Rajwani, K; Rasul, FT; Sadek, A-R; Schramm, M; Scicluna, G; Shafafy, R; Sharma, H; Sheikh, A; Sivasubramaniam, V; Sofela, A; Spink, G; Stokes, S; Strachan, E; Thakar, C; Thanabalasundaram, G; Ulbricht, C; Whitcher, A; White, D; Whitehouse, K; Wilby, M; Zolnourian, A |
| Publisher Information: |
Elsevier BV; England |
| Publication Year: |
2023 |
| Collection: |
PEARL (Plymouth Electronic Archiv & ResearchLibrary, Plymouth University) |
| Subject Terms: |
Cauda equina syndrome; Back pain; Urinary retention; Cohort study; Spinal surgery |
| Description: |
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. |
| Document Type: |
article in journal/newspaper |
| File Description: |
100545-100545; Electronic-eCollection; application/pdf |
| Language: |
English |
| ISSN: |
2666-7762 |
| Relation: |
E-ISSN:2666-7762; 100545; http://hdl.handle.net/10026.1/20355 |
| DOI: |
10.1016/j.lanepe.2022.100545 |
| Availability: |
http://hdl.handle.net/10026.1/20355; https://doi.org/10.1016/j.lanepe.2022.100545 |
| Accession Number: |
edsbas.E3696C3C |
| Database: |
BASE |