학술논문
Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: A multi-centre prospective cohort studyResearch in context
Document Type
article
Author
Julie Woodfield; Ingrid Hoeritzauer; Aimun A.B. Jamjoom; Josephine Jung; Simon Lammy; Savva Pronin; Cathal J. Hannan; Anna Watts; Laura Hughes; Richard D.C. Moon; Stacey Darwish; Holly Roy; Phillip C. Copley; Michael T.C. Poon; Paul Thorpe; Nisaharan Srikandarajah; Gordan Grahovac; Andreas K. Demetriades; Niall Eames; Philip J. Sell; Patrick F.X. 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; Afsand Baig Mirza; Antony Bateman; Iwan Bennett; Imran Bhatti; Peter Bodkin; Lalasa Bommireddy; George Bonanos; Anouk Borg; Alexandros Boukas; James Bourne; Rachael Brennan; Jennifer Brown; Katie Brown; Oliver Burton; Christopher Busby; Neil Chiverton; Simon Clark; Phillip C Copley; Simon Cudlip; Yan Cunningham; Ronan Dardis; Benjamin Davies; Andreas K Demetriades; Saurabh Deore; Chris Derham; Muhammad Dherijha; Gareth Dobson; James Duncan; Andrew Durnford; Alexander ZE Durst; Edward W Dyson; Ellie Edlmann; Andrew Edwards-Bailey; Anne Elserius; Becca Elson; Mohammed Fadelalla; Daniel M Fountain; Adrian Gardner; Arnab Ghosh; James R Gill; Stella A Glasmacher; Robin Gordon; Rebecca Grenfell; Awais Habeebullah; Nikolaos Haliasos; Tim Hammett; Cathal John Hannan; Ciaran Scott Hill; David Holmes; Kismet Hossain-Ibrahim; Muhammad Hussain; Shakir Hussain; Ramez Ibrahim; Aimun AB Jamjoom; Bethan John; Shabin Joshi; Oliver Kennion; Muhammad Khan; Adriana Klejnotowska; Ashwin Kumaria; Roberta LaCava; Alistair Lawrence; Matthew Lea; Andraay HC Leung; Ignatius Liew; Weisang Luo; Oscar MacCormac; James Manfield; Richard Mannion; Joseph Merola; Pranav Mishra; Khalid Abubaker Mohmoud; Richard Moon; Rory Morrison; Odhran Murray; Ali Nader-Sepahi; Colin Nnandi; Anand Pandit; Nitin Patel; Anita Philip; Michael TC Poon; Kuskoor Seethram Manjunath Prasad; Shyam Pujara; Balaji Purushothaman; Kapil Rajwani; Fahid Tariq Rasul; Ahmed-Ramadan Sadek; Moritz Schramm; Gabrielle Scicluna; Philip J Sell; Roozbeh Shafafy; Himanshu Sharma; Asim Sheikh; Vinothan Sivasubramaniam; Agbolahan Sofela; George Spink; Patrick FX Statham; Stuart Stokes; Euan Strachan; Chrishan Thakar; Gopiga Thanabalasundaram; Christian Ulbricht; Alison Whitcher; David White; Kathrin Whitehouse; Martin Wilby; Ardalan Zolnourian
Source
The Lancet Regional Health. Europe, Vol 24, Iss , Pp 100545- (2023)
Subject
Language
English
ISSN
2666-7762
Abstract
Summary: 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.