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

Woodfield, J. et al. (2023) 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. Lancet Regional Health - Europe, 24, 100545. (doi: 10.1016/j.lanepe.2022.100545) (PMID:36426378) (PMCID:PMC9678980)

Abstract

Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lammy, Dr Simon
• Authors: Woodfield, J., Hoeritzauer, I., Jamjoom, A. A.B., Jung, J., Lammy, S., Pronin, S., Hannan, C. J., Watts, A., Hughes, L., Moon, R. D.C., Darwish, S., Roy, H., Copley, P. C., Poon, M. T.C., Thorpe, P., Srikandarajah, N., Grahovac, G., Demetriades, A. K., Eames, N., Sell, P. J., Statham, P. F. X., UCES Collaborators, ., and British Neurosurgical Trainee Research Collaborative, .
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Lancet Regional Health - Europe
• Publisher: Lancet Publishing Group
• ISSN: 2666-7762
• ISSN (Online): 2666-7762
• Published Online: 17 November 2022
• Copyright Holders: Copyright © 2022 The Authors.
• First Published: First published in Lancet Regional Health - Europe 24:100545
• Publisher Policy: Reproduced under a Creative Commons license