Guidelines for Cauda Equina Syndrome Management

Abstract

The cauda equina syndrome (CES) is an urgent situation which needs immediate surgery. However, proper diagnosis is often confused. There are some clinical check points; bilateral radiculopathy, impaired perineal sensation, impaired anal tone, and urinary retention. In addition, magnetic resonance image should match the clinical symptom. With these clinical and radiographic evidences, we can classify CES as CES suspected or suspicious (CESS), incomplete CES (CESI), and CES with neurogenic retention of urine (CESR). All these situations may need surgery, however, the timing of surgery and neurologic outcomes are various. Herein we prescribe the guideline for proper treatment strategy of CES.

Suspected Cauda Equina Syndrome: Can the Presence of an Orthopaedic Doctor in the Emergency Department Reduce Waiting Times for MRI Scans and Inpatient Stays?

“…Those affected with only bilateral radiculopathy and/or subjective urinary/bowel dysfunction or perineal anaesthesia and no objective evidence of CES would be classified as CES-Suspected (CES-S). Those with objective symptoms of CES but have normal bowel or bladder function are classified as CES-Incomplete (CES-I), and those with objective symptoms and with urinary retention and overflow incontinence are classified as CES-Retention (CES-R) [6].…”

Case report: incomplete Cauda Equina Syndrome following a caesarean section with spinal anaesthesia

“…The causes, in a healthy patient who undergoes a caesarean section, can be varied and all related to neuraxial anaesthesia. The most frequent are: an epidural haematoma [3][4][5][6], a trauma to the intervertebral disc, with leakage of its contents by insertion of the needle [7][8][9], infections by incorrect sterilization of the surgical field or of the instrumentation used [10] and a chemical arachnoiditis from local anaesthetics [11][12][13][14]. In the case analysed in this article, the cause is most likely the last of those mentioned: a hyperbaric bupivacaine arachnoiditis administered at a concentration of 0.5%.…”