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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

2022; Elsevier BV; Volume: 24; Linguagem: Inglês

10.1016/j.lanepe.2022.100545

2666-7762

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

Anesthesia and Pain Management

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. 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. 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. 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. DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.