UMEM Educational Pearls

Category: Orthopedics

Title: Cauda Equina Syndrome (CES)

Keywords: back pain, back emergency (PubMed Search)

Posted: 3/9/2019 by Brian Corwell, MD (Updated: 8/25/2019)
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Cauda Equina Syndrome (CES)

 

A recent pearl discussed CES. This is a very challenging diagnosis to make, especially on initial presentation

The 5 “classic” characteristic features are

  •  Bilateral radiculopathy
  • Saddle anesthesia
  • Altered bladder function
  • Loss of anal tone
  • Sexual dysfunction

Not all symptoms will be present in a given patient and there is no sign/symptom combination that either reliably diagnoses or excludes CES.

To illustrate how difficult this diagnosis is to make, a study looked at the predictive abilities of Neurosurgical residents.

Positive MRI for CES was accurately predicted by senior neurosurgical residents in approximately 50% of patients suspected of CES based on history and physical findings. As clinical certainty only becomes apparent with the classic symptoms (which are generally late findings) waiting to initiate MRI will delay decompressive surgery and can lead to worsened functional outcomes. This leads to increased MRI demand with more negative MRIs. Not surprisingly, only ~20% of MRI scans for suspected CES are positive.

 

References

Bell DA et al. Cauda equina syndrome: what is the correlation between clinical assessment and MRI scanning? Br J Neurosurg 2007;21:201-3.