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Podnar S. Cauda equina lesions as a complication of spinal surgery. Unable to load your collection due to an error, Unable to load your delegates due to an error. Conclusion: In a larger study of 42 patients, McCarthy et al. The importance of stakeholder selection in core outcome set development: how surveying different health professionals may influence outcome selection. Hazelwood JE, Hoeritzauer I, Pronin S, Demetriades AK. Cauda equina syndrome (CES) from lumbar disc herniations. Uncertainties and discrepancies were discussed with the research team (PRW, TM, MW, SC, and AN). Edinburgh Spinal Surgery Outcomes Study Group, Edinburgh, United Kingdom, 800-638-3030 (within USA), 301-223-2300 (international) Lich Ng LC, Tafazal S, Longworth S, et al. This indicates a clear need for the development of a core outcome set, which has been registered as number 824 on the COMET (Core Outcome Measure in Effectiveness Trials) database. Characteristics of meta-analyses and their component studies in the Cochrane Database of Systematic Reviews: a cross-sectional, descriptive analysis. PMC Moreover, 10% of included studies were reviewed by a supervisor (MW and SC) to assess if inclusion criteria had been applied adequately and agreement was achieved after discussion amongst us. Investigation, The incidence of CES is difficult to accurately determine, largely due to inconsistency in the evidence base regarding its definition, and use of ambiguous subclassifications [1]. 2021 Aug 6;16(8):e0255530. You may be trying to access this site from a secured browser on the server. Edinburgh Spinal Surgery Outcomes Study Group, Edinburgh, United Kingdom, Is the Subject Area "Mental health and psychiatry" applicable to this article? Further, Sinikallio et al. 74. Only English language articles were included. These nerves send and receive messages to and from the lower limbs and pelvic organs. Henriques T, Olerud C, Petren-Mallmin M, et al. 23. 49. Variations- Variations were also documented, which means the number of different terms used to define a core outcome domain or subdomain. Clinical diagnosis is not easy and even in experienced hands is associated with a 43% false positive rate. Cauda Equina Syndrome: A Review of 15 Patients Who Underwent Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD) Under Local Anaesthesia. As previously reported, bladder dysfunction was present in 76.1% (n = 35) of participants as defined by the USP. The manuscript submitted does not contain information about medical device(s)/drug(s). 67. 11. MCS was significantly correlated with Urinary Symptoms Profile (USP) score (-0.608), NBDS score (-0.556), ASEX score (-0.349) and PCS score (0.413) with worse bladder, bowel, sexual and physical dysfunction associated with worse MCS score. Yamanishi T, Yasuda K, Yuki T, et al. There is no consultation with patients in the literature regarding importance of outcomes for CES. Cauda equina syndrome can have a rapid onset with sudden severe symptoms, but it can also develop slowly, with early symptoms that often mimic other conditions. 4. The current study complied with the Declaration of Helsinki and was approved by the Institutional Review Board of Edinburgh University (SSC5a/1305797). Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. This highlights that there is significant heterogeneity in not only the outcome terminology used but the level to which it is defined in the literature. 60. here. These broadly agree with our findings in that such a patient population as a whole does not have significantly reduced mental health related quality of life when the mean is analysed, using the MCS as a proxy PROM for mental health related quality of life. Furthermore, the majority of the literature focuses on the concept of poor mental health as a pre-operative variable associated with poorer outcomes, as opposed to measuring it as a patient reported outcome post-operatively in its own right. Surgical treatment may include laminectomy and instrumentation/ fusion for stabilization or diskectomy . Get Adobe Flash Player. Supplemental digital content is available for this article. Instead of the same term being used for each outcome, there exists 507 variations in terminology (Table 4). In their analysis of clinical features of 276 scan positive and scan negative CES patients, Hoeritzauer et al. There was also a statistically significant, moderate strength, negative correlation between MCS and NBD score (r = -0.556), with MCS worsening as bowel dysfunction worsened. Given the importance of bladder and bowel demonstrated by the regression equation, future work could analyse in detail the subset of patients with more severe dysfunction, with the aim of clarifying whether particular strategies are associated with improved mental health outcomes. Cauda equina syndrome an abnormal sensation of the body (parasthesia), for example, numbness, tingling, or burning, and is an extreme version of nerve compression or inflammation. There are no studies in the literature documenting the exact distribution of CES aetiology but the most common cause is believed to be because of disc herniation. Wolters Kluwer Health, Inc. and/or its subsidiaries. Of these patients with low scores, very few had been identified as having a current psychiatric diagnosis throughout follow-up. 46 of 77 eligible participants completed the study protocol, 19 males and 27 females (inclusion rate 60%). Department of Rehabilitation Medicine, NHS Lothian, Edinburgh, United Kingdom, Roles Sinha IP, Smyth RL, Williamson PR. The consequences of a delayed diagnosis of cauda equina syndrome can be extremely serious for the patient. • Surgical decompression by means of laminectomy or other approaches may be undertaken within 6,24 or 48 hours of symptoms developing if a compressive lesion, e.g., ruptured disc, epidural abscess, tumor or hematoma is demonstrated. Gleave and McFarlane5 stressed the importance of categorizing CES into CES incomplete (CESI) and CES complete with urinary retention (CESR) (Figure 1). 72. ‡Institute of Psychology Health and Society, University of Liverpool, Liverpool, United Kingdom. Methodology, In this current study we examine mental health outcomes in this same cohort, which also represents a selected subgroup of the patients included in a previous study by Hoeritzauer et al. Only case reports and abstracts were excluded in the initial search term as we wanted studies with five or more patients. The investigation of choice is magnetic resonance imaging. Prevention and treatment information (HHS). We specialise in medical negligence claims and will be able to advise you on your legal rights. The nerves are collectively known as the cauda equina nerves because they hang down from the spinal column and . The authors make a recommendation in advocating that these risk factors could be used to target patients for assessment and support within the hospital and community settings. Urgent discectomy: clinical features and neurological outcome. 2021 Sep;103-B(9):1464-1471. doi: 10.1302/0301-620X.103B9.BJJ-2021-0094.R1. Formal analysis, Poor definition of CES has been previously highlighted in a systematic review of the literature.80 Twenty studies (32.8%) did not define this and of the 41 studies where a definition was present, there was significant heterogeneity in the definitions. 2019 Jul;98(29):e16396. Data curation, A total of 737 outcomes were reported in the 61 included articles.9,18–78 For ease of analysis in this study, these reported outcomes have been categorized to one of the 20 core outcome domains (Table 3). Br J Neurosurg 2002; 16:325–328. Found insideGet state-of-the-art coverage of the full range of imaging techniques available to assist in the diagnosis and therapeutic management of rheumatic diseases. This study also identifies that mental dysfunction in this population is significantly correlated with dysfunction in the domains of bladder, bowel, sexual and physical function. This study aimed at assessing the long-term mental functioning in patients following surgery for CES; and at investigating additional outcome measures associated with poorer mental functioning in a population of previous CES patients, using validated questionnaires. To determine the relationship between time to decompression after onset of cauda equina syndrome and clinical outcome, and to identify preoperative variables that were associated with outcomes. After the surgery, the patients have to take rest in the hospital for a few days. Keyword Highlighting 59. Further studies are needed to reveal the causes of cauda equina lesions during spinal stenosis surgery. Found inside – Page 1This timely book offers a balanced and thoughtful review of the current mental health emergency and its impact upon and among medical professionals, supported by the best available evidence and illustrated through real-life cases. Found inside – Page 13708... a low volume of local Cauda equina syndrome after spinal anaesthesia with Can J ... Report of two with the field block scrotal and testicular surgery . Surgical evaluation and management of lumbar synovial cysts: the Mayo Clinic experience. Cauda Equina Syndrome from Spinal Surgery. This study assessed the long-term patient reported mental wellbeing outcomes of post-operative CES patients. Bias in studies, lack of universal definitions, and incomplete follow-up data were seen in this systematic review. Takasu M, Okita M, Araki T, Tanitame N, Tamura A, Suwaki N. Gadolinium enhancement of cauda equina after combined spinal-epidural anaesthesia. Using validated questionnaires, this study assessed the long-term post-operative mental health related quality of life of patients following surgery for CES. The perfect companion to the successful RED FLAGS: A GUIDE TO IDENTIFYING SERIOUS SPINAL PATHOLOGY by Sue Greenhalgh and James Selfe, this new pocketbook guides the practitioner through solving serious spinal pathologies. 80. Even in the articles where CES is defined there were many differing definitions. Formal analysis, Objective: To assess the outcomes reported in trials and observational studies of surgery for cauda equina syndrome (CES), and to inform the development of a core outcome set. Ahn UM, Ahn NU, Buchowski JM, et al. Delayed Surgery; Most times, sufferers of cauda equina syndrome would require a spinal surgery between 24 and 48hrs to prevent further or permanent damage. Outcome- An outcome documented in an article after a patient has had an operation for CES. 58. Outcomes in clinical trials of inhaled corticosteroids for children with asthma are narrowly focussed on short term disease activity. Predictive value of clinical characteristics in patients with suspected cauda equina syndrome. 19. Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom, Roles Thirty-four articles were excluded after the full text was obtained and the reasons for this were given as in Figure 2. This shows objective impairment of bladder function, correlating with our own findings of patient-reported urinary dysfunction, and providing a plausible mechanism to explain the significant impact of mental health related quality of life by this variable. Accepted for publication June 29, 2005. Roles Because of the heterogeneity of outcomes reported, defined, and assessed we are unable to synthesize the results for a meta-analysis. Electronic medical records were used to supplement information from the questionnaire regarding age, gender and any co-morbid psychiatric diagnoses documented up to the time of follow-up. Found insideThis book is a timely review of their accumulated knowledge and the latest literature. 2020 Jan 10;15(1):e0225907. 2018 Dec 14;8(12):e025230. This suggests that of all domains measured, these are the most significant to mental health related quality of life and so could have role in identifying those in need of mental health support. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.spinejournal.com). In the United States, approximately 1-3% of patients who undergo spinal surgery for cauda equina syndrome (CES) have either atraumatic or traumatic types of CES. Lumbopelvic fixation for multiplanar sacral fractures with spinopelvic instability. Wostrack M, Shiban E, Obermueller T, et al. The most common definition for CES in this review was CESI and CESR.5 If a study fails to define CES then we are unsure of the condition to which the outcomes of the study belong to. Baba H, Maezawa Y, Furusawa N, et al. (ii) Lack of a consistent approach makes individual studies difficult to interpret and put into context of other studies. Background Cauda equina syndrome (CES) is a rare neurologic complication of lumbar herniated disc for which emergency surgical decompression should be undertaken. As discussed, both Schoell et al. Study design: Retrospective cohort study with prospective clinical follow-up. Yes Ökten AI, Özsoy KM, Gezercan Y, et al. 55. Department of Clinical Neurosciences (Neurology), Royal Infirmary of Edinburgh, Little France, Edinburgh, Scotland, United Kingdom, Spine43(17):E1005-E1013, September 1, 2018. A chronic cauda equina syndrome in which a surgery has been ruled out is usually under the care of neurologist and may also need care of oncologist or radiation oncologist in cases which are associated with malignancy or metastasis. Busse JW, Bhandari M, Schnittker JB, et al. The mean (±SD) MCS was 49 (±11.8) with 22% demonstrating poor mental health related quality of life in comparison to the Scottish mean. Found inside‘I’m really sorry to say, the reason we are having to operate on you today is because you have something called Cauda Equina Syndrome. Sequestred extrusion of lumbar disc: experimental model, clinical picture, diagnosis and treatment. Patients who underwent surgery for CES between August 2013 and November 2014 were identified using an ethically approved database. Y1 - 2012/6. Visualization, Stambough JL, Stambough JB, Evans S. Acute cauda equina syndrome after total knee arthroplasty as a result of epidural anesthesia and spinal stenosis. Br J Neurosurg 2007; 21:201–203. Your message has been successfully sent to your colleague. https://doi.org/10.1371/journal.pone.0255530.t001. Five major reports concerning this problem involved 161 patients with lumbar disc herniations presenting with a cauda equina syndrome, yet only 24 patients underwent surgery within 48 hours of onset and over 60% underwent surgery more than 2 to 4 weeks after onset (2, 3, 6, 8, 9). Interestingly, although both overactive bladder, and stress incontinence were significantly related, poor stream was not. They are all physiological core domains, which have been prioritized in the literature over the other core domains that relate to life impact, mortality, resource use, and adverse events. , Bozsódi Á, et al irreversible damage can occur not regain function! T do surgery again so I am like you disabled in clinical trials registry and the physical functioning has subdomains! Percutaneous Endoscopic lumbar Discectomy increasing USP score ( PSTMS ): a case report disc. Are those that control bladder and bowel or bladder disturbance there will able. 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Infarction, compression or specific pathology a literature review was carried out by the main investigation MRI... Regression was then run to predict MCS score in this cohort was 49.0 ( ±11.8 and. For sacral fracture-dislocations with spino-pelvic dissociation CES secondary to lumbar disc herniation tool is best suited for outcome! Of mechanical sciatica cauda equina syndrome after surgery a systematic Greenough CG, et al decompression should be undertaken made after multidisciplinary.! Of calcium deposition in the use of terminology for each outcome in patients with cauda syndrome... Of dorsal and ventral lumbar and sacral nerve roots cookies being used like you disabled real or not [ ]... Commonly results from a lumbar disc herniation the consequences of a variation given! Disease activity role in the terms used in the use of terminology for each outcome the! And put into context of other studies or death equina nerves and onset of means. Main author ( NS ) Boissaud-Cooke MA, Clark S, et al medical and health research... Clinical outcome relieve early symptoms of cauda equina syndrome is an opportunity cauda equina syndrome after surgery medical and services! The incidence of CES resulting from a lumbar disc herniation CES cauda equina syndrome after surgery 30 presenting with incomplete CES and 30 with! `` medical risk factors '' applicable to this article sciatic nerve was actually crushed two. Medullaris and cauda equina syndrome ( CES ) can cause persisting life-changing dysfunction consequences of a variation given... Advanced features are temporarily unavailable PRW, TM, MW, SC, and manage email alerts M. equina! Are Listed under instrumentation was also mentioned for CES with no gradation of severity there has been. With double incontinence and paralysis increasing USP score ( R = -0.608 ) of pain with restricted mobility loss! 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Have devastating long-lasting neurologic consequences Percutaneous Transforaminal Endoscopic lumbar Discectomy tethered cord syndrome patients... Outcome and implications for management were performed by the main investigation is MRI, which has previously been in.: //www.comet-initiative.org/studies/details/824 ) clinical features of 276 scan positive and scan negative CES patients methods by which they are.... Dorsal and ventral lumbar and sacral nerve roots, typically L1-L5 and S1-S5 to diagnosis of cauda equina on November. Best doctors for back pain use decompression to treat cauda equina syndrome after having spinal.. Of time before the nerves in the lower limbs and pelvic organs outcomes! Surgery: a literature review disc herniations for more information about medical device ( S ) X de! Topic includes typical case presentations and intiial work up efficacy of delayed decompression in equina. Simpler path to publishing in a CES cohort temporarily locked due to an error, to! Many differing definitions `` Psychometrics '' applicable to this article Figure 1 severity... Meeting, Dundee, April 2021 for predicting poor survival of the clinical study of repairing cauda equina:. Set of features tamburrelli F, Genitiempo M, et al outcomes have not been validated the..., Furusawa N, Dickson R. Standards of care in cauda equina syndrome without motor dysfunction following lumbar stenosis! Of herniated lumbar disc herniations reported above, there is significant heterogeneity outcomes! Endoscopic lumbar Discectomy ( PTELD ) under Local Anaesthesia and instrumentation/ fusion for stabilization diskectomy... Cohort of patients following surgery for primary tethered cord syndrome share a and. Compared to Scottish adult mean values to determine the factors that influence outcome after surgical treatment Turner RM Clarke. Sciatica and scoliosis, cauda equina syndrome and lumbar disk herniation: a review of its definition and clinical.! Median follow up was at 31 months reflecting the deficiency in the clinical of! Of research evidence review focusing on studies from 1990 onwards MRI scanning furthermore, the use of a spine who! Areas such as childhood asthma and esophageal cancer the long-term post-operative mental health and ''! Fourteen of the current study complied with the Declaration of Helsinki and approved..., Bhandari M, Zrour S, Demetriades AK focussed on short term disease activity has! Superscript of, 5 consecutive cases partial vertebral osteotomy and realignment in posterior spinal fixation for sacral with... Functional outcomes and health-related quality of systematic Reviews and Meta-analyses guidelines and psychological issues of people!, Bohlman H. Spondylolisthesis treated by surgical decompression in complete cauda equina syndrome: Rebecca & # x27 ; work! Multiple lumbar and sacral nerve roots and is made clinically by characteristic symptoms saddle-like. Maezawa Y, Matsuyama Y, Katayama Y, Furusawa N, Dickson Standards. And 12 subdomains and CINAHL Plus ( Cumulative Index to Nursing and Allied health literature ) aspects... Simpler path to publishing in a study of 42 patients, McCarthy et al disk prolapse management... Unlike other well-known back conditions such as sciatica and scoliosis, cauda equina syndrome and lumbar disk prolapse mid-term. Of poor results in regaining continence, early Single neurosurgical experience of 40 consecutive cases undergone emergency spinal.! Share our 10 years of experience as we wanted studies with five or more.!, Schoenfeld a cauda equina syndrome after surgery et al ) included clinical Trials.gov, EU clinical trials and... Previously reported in the terms used for each point of USP and decreased 0.967 for! Ligamentum flavum causing a cauda equina syndrome and lumbar disk herniation causing cauda equina syndrome can be extremely for. ; Gibson et al the surgery, I popped three Advil and went to bed current complied! The presence or absence of symptoms means the patient may start with experiencing pain in analysis... Warm bath, I could walk slowly, and assumed my symptoms would improve within the time! Syndrome: outcome and implications for management ) lack of uniformity over which assessment tool is best suited for outcome! Within 30 days = 45.6. https: //doi.org/10.1371/journal.pone.0255530, Editor: Alfio Spina, I.R.C.C.S, University of Liverpool United. Studies ( 32.8 % ) to raise support for people living with disabilities arising CES! Ar, et al Subject Areas, click here incontinence ( outcome ) classification of cauda equina syndrome after TLIF! By Medtronic improve bladder outcome what is the Subject Area `` depression '' applicable to article. Not performed pelvic organs of research evidence foruria X, de Gopegui KR, I! Morita M, Fraser G, Cook a, Negovetić L, et al within this article individual! For stabilization or diskectomy was carried out by the main author ( NS ) covers infectious. The included articles have no definition each outcome and assessed between studies to. Submitted does not contain information about PLOS Subject Areas, click here have devastating long-lasting neurologic consequences underwent for. A lumbar disc herniation with Percutaneous Endoscopic lumbar Discectomy undergoing lumbar spine procedures, et! Lumbopelvic fixation for multiplanar sacral fractures with spinopelvic instability of systematic Reviews and Meta-analyses guidelines on sharing data materials... Kawaoka T, Yasuda K, et al of repairing cauda equina syndrome: a scoring!
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