Assessment and management of cauda equina syndrome

Greenhalgh, Susan; Finucane, Laura; Mercer, C. F.; Selfe, James

doi:10.1016/j.msksp.2018.06.002

Cited by 45 publications

(34 citation statements)

References 19 publications

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“…However, findings of the present study are novel in reporting first‐hand accounts of physiotherapists suggesting that a clear CES pathway might also be beneficial to their wellbeing. The findings support previous suggestions that a robust and widely circulated pathway will help healthcare professionals to manage persons with suspected CES (Greenhalgh et al, 2018).…”

Section: Discussionsupporting

confidence: 90%

“…The findings of this study suggest that clear pathways, effective teamwork, communication aids and training might be practical steps to take to address the challenges faced by physiotherapists in managing persons with suspected CES. CES pathways have been recommended to be robust, widely circulated, accessible and agreed with all members of the multidisciplinary team (Greenhalgh et al, 2018). Development, evaluation and maintenance of pathways should be carefully considered to facilitate consistent, safe and effective care (Buchert & Butler, 2016) and current CES pathways for primary care should be in line with recent guidelines from the National Low Back Pain Clinical Network (2020).…”

Section: Discussionmentioning

confidence: 97%

“…CES pathways have been recommended to be robust, widely circulated, accessible and agreed with all members of the multidisciplinary team (Greenhalgh et al, 2018). Development, evaluation and maintenance of pathways should be carefully considered to facilitate consistent, safe and effective care (Buchert & Butler, 2016) and current CES pathways for primary care should be in line with recent guidelines from the National Low Back Pain Clinical Network (2020).…”

Section: Discussionmentioning

confidence: 99%

“…To confirm or deny diagnosis, imaging is often indicated on an emergency basis in order to facilitate timely decompression surgery (Germon et al, 2015). It has been suggested that management of persons with suspected CES may present a significant challenge to physiotherapists (Greenhalgh et al, 2018; Woods et al, 2015) but to the authors' knowledge, this has not previously been explored through empirical research. Therefore, this study aims to explore physiotherapists' experiences of managing persons with suspected CES.…”

Section: Introductionmentioning

confidence: 99%

“…Cauda equina syndrome (CES) is a rare, but potentially devastating condition (Greenhalgh, Finucane, Mercer, & Selfe, 2018). It is poorly defined in the literature, but usually refers to dysfunction of the sacral nerve roots in the lumbar spine (Fraser, Roberts, & Murphy, 2009; Kapetanekis et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Physiotherapists' experiences of managing persons with suspected cauda equina syndrome: Overcoming the challenges

Paling¹,

Hebron

2020

Musculoskeletal Care

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Introduction Cauda equina syndrome (CES) is rare, but its symptoms are not and musculoskeletal physiotherapists frequently encounter persons with suspected CES. Given that delayed diagnosis of CES can result in devastating consequences for affected persons and costly litigation for healthcare organisations, it is imperative that persons presenting with suspected CES are well managed. However, this may present a challenge to physiotherapists. Therefore, the aim of this study is to explore physiotherapists' experiences of managing persons with suspected CES. Methods Semi‐structured interviews were conducted with musculoskeletal physiotherapists. Verbatim transcripts were analysed using an interpretive paradigm and thematic analysis. Ethical approval Ethical approval was obtained from a university Ethics committee and NHS Research and Development. Findings Five interlinking themes emerged. The themes of worry in relation to risk management and communication difficulties seemed to represent significant challenges. The remaining themes were described as antidotes to these challenges: Lightening the load with teamwork and shared responsibility, the usefulness of a clear pathway and perception of improved confidence and competence with experience and training. Discussion The findings are discussed in the context of other literature, and practical recommendations are made relating to pathway implementation, team working, communication aids, training on CES and measures to care for staff wellbeing. Conclusion Findings suggest that it is important to be aware of and address the challenges faced by physiotherapists in order to care for clinicians' wellbeing and ensure a safe and smooth journey for persons with suspected CES. Summary Video: https://www.youtube.com/watch?v=lIHqCKIQ1jk&t=90s

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Physiotherapists' experiences of managing persons with suspected cauda equina syndrome: Overcoming the challenges

Paling¹,

Hebron

2020

Musculoskeletal Care

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A scoping review protocol: Investigating the extent and legal process of cauda equina syndrome claims for UK physiotherapists

Leech

Selfe

Ball

et al. 2021

Musculoskeletal Care

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Introduction: Cauda equina syndrome (CES) is a condition where early identification and treatment is crucial to avoid potentially devastating effects. There is a high number of litigation cases linked with CES given it is a relatively rare condition. This scoping review protocol proposes to explore the extent and process of CES litigation in UK healthcare context cases amongst UK physiotherapists. Methods and analysis:The methodological framework recommended by Arksey and O'Malley, Levac et al. and the Joanna Briggs Institute will be used throughout this review to aid reporting and transparency. A patient and public involvement (PPI) group meeting was convened at the beginning of the review process in order to provide knowledge exchange to inform the search strategy and propose resources to be used during the scoping review. Two reviewers will independently review the literature in order to apply the inclusion and exclusion criteria. Once the studies to be included have been identified, the data from these studies will be extracted and charted. Results will show quantitative data of the studies included in the review and a narrative synthesis of the literature.Dissemination: This scoping review will evaluate the existing knowledge relating to CES and litigation and will map the key concepts around this topic. Results will be disseminated to practitioners and policy-makers through peer-reviewed publications, conferences, reports and social media. This method may prove helpful to others who are investigating extent and processes relating to medicolegal cases involving healthcare practitioners.

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Neoplastic malignant cord compression mimicking low back pain: A case report

Cataldi

Brindisino

Angilecchia

et al. 2022

Physiotherapy Res Intl

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Background:The point prevalence of Cauda Equina Syndrome (CES) as a cause of Low Back Pain (LBP) is estimated at 0.04% in primary care, and it is reported as a complication in about 2% of patients with disc herniation. Compression of the cauda equina usually occurs as a result of disc prolapse. However, CES may be caused by any space-occupying lesion, including spinal stenosis, neoplasms, cysts, infection, and osteophytes. First contact physiotherapists may encounter patients with early CES, as the clinical presentation of CES can mimic non-specific LBP.Case presentation: This case report presents the medical history, diagnostic tests and relevant clinical data of a 52-year-old man complaining of LBP. The patient's medical history, his symptoms and the clinical findings led to the identification of a number of red flags (i.e. risk factors) suggestive of a non-musculoskeletal condition.The patient was referred to the emergency department for further investigation.Having undergone several diagnostic tests, the patient was diagnosed with CES due to malignancy. Conclusions:This case report highlights the importance of differential screening throughout the treatment period, in order to identify red flags that warrant further investigation and a referral to an appropriate specialist. Physiotherapy screening should include clinical reasoning, careful analysis of clinical presentation and symptom progression, in addition to appropriate referral for medical assessment and diagnostic imaging, if necessary. K E Y W O R D Scauda equina syndrome, differential diagnosis, low back pain, malignancy, physiotherapy | BACKGROUNDLow Back Pain (LBP) is a common condition, affecting 50%-80% of adults in their lifetime (Hoy et al., 2014;Koes et al., 2010;Oliveira & Maher, 2018). It has recently been identified as the most important cause of disability (Mesner et al., 2016) and remains a common condition among primary care patients, with an estimated lifetime prevalence of 13.8% for chronic pain and 80% for any episode of pain (Verhagen et al., 2016).European guidelines on the management of LBP in primary care define LBP as ''pain and discomfort localized below the costal margin and above the inferior gluteal folds, with or without leg pain'' (van Tulder et al., 2006). Non-specific LBP, commonly defined as LBP without any known cause (van Tulder et al., 2006), is diagnosed in about 90% of cases, due to unidentifiable underlying musculoskeletal causes (Fatoye et al., 2019;Koes et al., 2010;Oliveira & Maher, 2018). Patients with LBP may have neurological impairments, such as radiculopathy and neurological disorders, or a serious

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Assessment and management of cauda equina syndrome

Abstract: CES has significant implications for patients and clinicians alike. Timely, effective diagnosis and management of patients with CES results in a better outcome.

Cited by 45 publications

References 19 publications

Physiotherapists' experiences of managing persons with suspected cauda equina syndrome: Overcoming the challenges

Physiotherapists' experiences of managing persons with suspected cauda equina syndrome: Overcoming the challenges

A scoping review protocol: Investigating the extent and legal process of cauda equina syndrome claims for UK physiotherapists

Neoplastic malignant cord compression mimicking low back pain: A case report

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