What is the diagnostic accuracy of red flags related to cauda equina syndrome (CES), when compared to Magnetic Resonance Imaging (MRI)? A systematic review

Dionne, Nathalie; Adefolarin, Abiodun; Kunzelman, Dena; Trehan, Nitin; Finucane, Laura; Levesque, Lenerdene; Walton, David M.; Sadi, Jackie

doi:10.1016/j.msksp.2019.05.004

Cited by 40 publications

(36 citation statements)

References 25 publications

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“…Timely diagnosis is essential to avoid life-changing outcomes such as ongoing bladder, bowel, and sexual dysfunction, along with psychosocial consequences. 31 Literature and International Consensus Three key source papers were used to formulate the international consensus questionnaire for this section on CES 18,28,31 (APPENDIX B). The questionnaire was sent to 23 international experts and contained 25 items (TABLES 2 through 6).…”

Section: Cauda Equina Syndromementioning

confidence: 99%

“…66 Cauda equina syndrome is a complication of approximately 2% of all herniated discs. 18 The incidence of postoperative CES is estimated to be between 0.08% and 0.2%. 42 Twenty-three percent of litigation claims for spinal surgery in England relate to CES, according to an assessment of litigation claims in England between 2013-2015 and 2015-2016.…”

Section: Cauda Equina Syndromementioning

confidence: 99%

See 1 more Smart Citation

International Framework for Red Flags for Potential Serious Spinal Pathologies

Finucane

Downie

Mercer³

et al. 2020

Journal of Orthopaedic & Sports Physical Therapy

169

132

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about their care, even when faced with a serious diagnosis. Shared decision making is essential to ensure that individuals are supported to make decisions that are right for them. Using a collaborative process, the clinician should highlight the treatment options, evidence, risks, and benefits and, together with the person, seek to understand how these fit with that person's circumstances, goals, values, and beliefs. 56

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Section: Cauda Equina Syndromementioning

confidence: 99%

Section: Cauda Equina Syndromementioning

confidence: 99%

International Framework for Red Flags for Potential Serious Spinal Pathologies

Finucane

Downie

Mercer³

et al. 2020

Journal of Orthopaedic & Sports Physical Therapy

169

132

View full text Add to dashboard Cite

show abstract

“…Early decompression should be preceded by prompt workup with a confirmed diagnosis by an MRI scan as soon as possible, and since this includes detecting potential patients even outside working hours and on weekends, there must be a rationale to perform MRI scans in potential cases with all the economic and logistic implications especially in peripheral hospitals where no MRI service is available after hours and over weekends. In 2019, Dionne et al concluded that known clinical red flag symptoms are not sensitive enough to detect CES [6,17].…”

Section: Reviewmentioning

confidence: 99%

A Systematic Review of the Value of a Bladder Scan in Cauda Equina Syndrome Diagnosis

Alshahwani¹,

Boktor²,

Elbahi³

et al. 2021

Cureus

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Cauda equina syndrome (CES) is one of the emergency conditions that can lead to devastating permanent functional disabilities, if misdiagnosed. Multiple studies have questioned the reliability of clinical assessment in diagnosing CES, whether some of the features should be considered to be potential red flags. Bladder dysfunction can reflect CE compromise. The post-void residual (PVR) volume bladder scan is useful in CES diagnosis, but to date there has been no single systematic review supporting its use. Furthermore, there is no clear cut-off point to consider PVR statistically significant. The aim of the study is to perform a systematic review of the current evidence behind the use of the PVR bladder scan as a diagnostic tool for CES diagnosis. This was a comprehensive search using Medline, PubMed and Embase. All articles included post-void bladder scans with the mentioned clear cut-off volume as a diagnostic parameter. A total of five study articles from 1955 fit with our inclusion and exclusion criteria. The total number of patients who had a bladder scan was 531. CES was confirmed in 85 cases. Bladder scan diagnosed 70 cases and excluded 327. The best results for both sensitivity and specificity in correlation with the sample of the study were for PVR more than 200 ml. Measuring the post-void urine volume using a bladder scan is an essential tool in the diagnosis of CES. There is a significant correlation between the PVR volume more than 200 ml and higher sensitivity and specificity.

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“…2 Saddle anesthesia, bowel incontinence, reduced anal tone, leg pain, urinary retention, urinary incontinence, and back pain all have weak GRADE evidence for the diagnosis of cauda equina syndrome. 3 As such, no element of patient history or physical examination yields adequate sensitivities or specificities for the diagnosis of cauda equina syndrome, and definitive imaging must be pursued if the diagnosis is suspected.…”

Section: Can I Rule Out Cauda Equina Syndrome Clinically In the Ed?mentioning

confidence: 99%

Just the facts: Risk stratifying nontraumatic back pain for Cauda Equina Syndrome in the emergency department

Polsky

Greidanus

Pandya

et al. 2020

CJEM

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A 43-year-old male, with a history of chronic back pain, presents to the emergency department (ED) with acute onset chronic pain. He states he “tweaked something” and has been debilitated by back pain, radiating down both his legs, for 24 hours. He has not had a bowel movement but denies noticing any “saddle anesthesia.” His clinical exam is limited by pain, and it is difficult to determine if he has objective weakness. His perineal sensation is intact, as is his sensation upon digital rectal examination. The patient has a post-void residual of 250 mL, but you are unsure how to interpret this value. As an emergency physician, when should you suspect, and how should you evaluate cauda equina syndrome?

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What is the diagnostic accuracy of red flags related to cauda equina syndrome (CES), when compared to Magnetic Resonance Imaging (MRI)? A systematic review

Cited by 40 publications

References 25 publications

International Framework for Red Flags for Potential Serious Spinal Pathologies

International Framework for Red Flags for Potential Serious Spinal Pathologies

A Systematic Review of the Value of a Bladder Scan in Cauda Equina Syndrome Diagnosis

Just the facts: Risk stratifying nontraumatic back pain for Cauda Equina Syndrome in the emergency department

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