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Understanding cauda equina syndrome: a UK multicentre prospective observational cohort study
EANS Academy. Woodfield J. 09/26/19; 275965; EP02064
Ms. Julie Woodfield
Ms. Julie Woodfield

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Abstract
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Background: Cauda equina syndrome (CES) occurs infrequently but can have important medical, social, and legal consequences.
Methods: This is a prospective observational cohort study of adults with clinical and radiologically confirmed CES. Patients are identified during admission to UK spinal centres. Follow up occurs for one year and patient reported outcome measures includes visual analogue scores (VAS) for back and leg pain, the Oswestry Disability Index (ODI), the neurogenic bowel dysfunction score, the short form incontinence questionnaire and the Arizona sexual experiences scale.
Results: Participant recruitment runs from June 2018 to May 2019. In February 2019, 335 patients (55% female, median age 43 years) from 32 centres were included. 268/335 (80%) patients were identified during their emergency admission. 243/335 (73%) had consented for questionnaire follow up, 209 had been sent admission and discharge questionnaires and there was a 58% response rate. On admission, 79% reported bladder dysfunction, 22% bowel dysfunction, 26% sexual dysfunction, and 66% saddle numbness. Digital rectal examination was abnormal in 50%, a urinary catheter was required in 37%, and only 27% were mobilising normally. Mean VAS on admission was 8/10 for back pain and 8/10 for pain in the worst leg. The median ODI was 66%. Decompression occurred as an emergency in 80% and the primary surgeon was a consultant in 36%. By discharge, 42% had complete resolution of symptoms, only 12% required a catheter, and 55% had normal mobility. Mean VAS on discharge was significantly decreased to 4/10 (p< 0.001) for back pain and 3/10 (p< 0.001) for leg pain.
Conclusion: This is already one of the largest studies of CES and recruitment and follow up reminders continue. Patients are significantly disabled on admission but improvement is seen following decompression. We will assess longer term outcomes and stratify these by presentation, investigation and management.
Background: Cauda equina syndrome (CES) occurs infrequently but can have important medical, social, and legal consequences.
Methods: This is a prospective observational cohort study of adults with clinical and radiologically confirmed CES. Patients are identified during admission to UK spinal centres. Follow up occurs for one year and patient reported outcome measures includes visual analogue scores (VAS) for back and leg pain, the Oswestry Disability Index (ODI), the neurogenic bowel dysfunction score, the short form incontinence questionnaire and the Arizona sexual experiences scale.
Results: Participant recruitment runs from June 2018 to May 2019. In February 2019, 335 patients (55% female, median age 43 years) from 32 centres were included. 268/335 (80%) patients were identified during their emergency admission. 243/335 (73%) had consented for questionnaire follow up, 209 had been sent admission and discharge questionnaires and there was a 58% response rate. On admission, 79% reported bladder dysfunction, 22% bowel dysfunction, 26% sexual dysfunction, and 66% saddle numbness. Digital rectal examination was abnormal in 50%, a urinary catheter was required in 37%, and only 27% were mobilising normally. Mean VAS on admission was 8/10 for back pain and 8/10 for pain in the worst leg. The median ODI was 66%. Decompression occurred as an emergency in 80% and the primary surgeon was a consultant in 36%. By discharge, 42% had complete resolution of symptoms, only 12% required a catheter, and 55% had normal mobility. Mean VAS on discharge was significantly decreased to 4/10 (p< 0.001) for back pain and 3/10 (p< 0.001) for leg pain.
Conclusion: This is already one of the largest studies of CES and recruitment and follow up reminders continue. Patients are significantly disabled on admission but improvement is seen following decompression. We will assess longer term outcomes and stratify these by presentation, investigation and management.
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