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
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. M...
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-01-01
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| Series: | The Lancet Regional Health. Europe |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666776222002411 |
| _version_ | 1798017202327126016 |
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| 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 Stacey Darwish Benjamin Davies Andreas K Demetriades Saurabh Deore Chris Derham Muhammad Dherijha Gareth Dobson James Duncan Andrew Durnford Alexander ZE Durst Edward W Dyson Niall Eames 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 Gordan Grahovac Rebecca Grenfell Awais Habeebullah Nikolaos Haliasos Tim Hammett Cathal John Hannan Ciaran Scott Hill Ingrid Hoeritzauer David Holmes Kismet Hossain-Ibrahim Laura Hughes Muhammad Hussain Shakir Hussain Ramez Ibrahim Aimun AB Jamjoom Bethan John Shabin Joshi Josephine Jung Oliver Kennion Muhammad Khan Adriana Klejnotowska Ashwin Kumaria Roberta LaCava Simon Lammy 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 Savva Pronin Shyam Pujara Balaji Purushothaman Kapil Rajwani Fahid Tariq Rasul Holly Roy Ahmed-Ramadan Sadek Moritz Schramm Gabrielle Scicluna Philip J Sell Roozbeh Shafafy Himanshu Sharma Asim Sheikh Vinothan Sivasubramaniam Agbolahan Sofela George Spink Nisaharan Srikandarajah Patrick FX Statham Stuart Stokes Euan Strachan Chrishan Thakar Gopiga Thanabalasundaram Paul Thorpe Christian Ulbricht Anna Watts Alison Whitcher David White Kathrin Whitehouse Martin Wilby Julie Woodfield Ardalan Zolnourian |
| author_facet | 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 Stacey Darwish Benjamin Davies Andreas K Demetriades Saurabh Deore Chris Derham Muhammad Dherijha Gareth Dobson James Duncan Andrew Durnford Alexander ZE Durst Edward W Dyson Niall Eames 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 Gordan Grahovac Rebecca Grenfell Awais Habeebullah Nikolaos Haliasos Tim Hammett Cathal John Hannan Ciaran Scott Hill Ingrid Hoeritzauer David Holmes Kismet Hossain-Ibrahim Laura Hughes Muhammad Hussain Shakir Hussain Ramez Ibrahim Aimun AB Jamjoom Bethan John Shabin Joshi Josephine Jung Oliver Kennion Muhammad Khan Adriana Klejnotowska Ashwin Kumaria Roberta LaCava Simon Lammy 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 Savva Pronin Shyam Pujara Balaji Purushothaman Kapil Rajwani Fahid Tariq Rasul Holly Roy Ahmed-Ramadan Sadek Moritz Schramm Gabrielle Scicluna Philip J Sell Roozbeh Shafafy Himanshu Sharma Asim Sheikh Vinothan Sivasubramaniam Agbolahan Sofela George Spink Nisaharan Srikandarajah Patrick FX Statham Stuart Stokes Euan Strachan Chrishan Thakar Gopiga Thanabalasundaram Paul Thorpe Christian Ulbricht Anna Watts Alison Whitcher David White Kathrin Whitehouse Martin Wilby Julie Woodfield Ardalan Zolnourian |
| author_sort | Julie Woodfield |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-11T16:03:15Z |
| format | Article |
| id | doaj.art-dd87b3fe295b4fbebccc6b4cb3a5d53e |
| institution | Directory Open Access Journal |
| issn | 2666-7762 |
| language | English |
| last_indexed | 2024-04-11T16:03:15Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Europe |
| spelling | doaj.art-dd87b3fe295b4fbebccc6b4cb3a5d53e2022-12-22T04:14:55ZengElsevierThe Lancet Regional Health. Europe2666-77622023-01-0124100545Presentation, 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 contextJulie Woodfield0Ingrid Hoeritzauer1Aimun A.B. Jamjoom2Josephine Jung3Simon Lammy4Savva Pronin5Cathal J. Hannan6Anna Watts7Laura Hughes8Richard D.C. Moon9Stacey Darwish10Holly Roy11Phillip C. Copley12Michael T.C. Poon13Paul Thorpe14Nisaharan Srikandarajah15Gordan Grahovac16Andreas K. Demetriades17Niall Eames18Philip J. Sell19Patrick F.X. Statham20Mohamed AbdelsadgMotaz MS AbulailaUsman AhmedQasim AjmiRafid Al-MahfoudhChadi AliMeriem AmaroucheAmin AndalibMohit AroraMukul AroraMariam AwanAfsand Baig MirzaAntony BatemanIwan BennettImran BhattiPeter BodkinLalasa BommireddyGeorge BonanosAnouk BorgAlexandros BoukasJames BourneRachael BrennanJennifer BrownKatie BrownOliver BurtonChristopher BusbyNeil ChivertonSimon ClarkPhillip C CopleySimon CudlipYan CunninghamRonan DardisStacey DarwishBenjamin DaviesAndreas K DemetriadesSaurabh DeoreChris DerhamMuhammad DherijhaGareth DobsonJames DuncanAndrew DurnfordAlexander ZE DurstEdward W DysonNiall EamesEllie EdlmannAndrew Edwards-BaileyAnne ElseriusBecca ElsonMohammed FadelallaDaniel M FountainAdrian GardnerArnab GhoshJames R GillStella A GlasmacherRobin GordonGordan GrahovacRebecca GrenfellAwais HabeebullahNikolaos HaliasosTim HammettCathal John HannanCiaran Scott HillIngrid HoeritzauerDavid HolmesKismet Hossain-IbrahimLaura HughesMuhammad HussainShakir HussainRamez IbrahimAimun AB JamjoomBethan JohnShabin JoshiJosephine JungOliver KennionMuhammad KhanAdriana KlejnotowskaAshwin KumariaRoberta LaCavaSimon LammyAlistair LawrenceMatthew LeaAndraay HC LeungIgnatius LiewWeisang LuoOscar MacCormacJames ManfieldRichard MannionJoseph MerolaPranav MishraKhalid Abubaker MohmoudRichard MoonRory MorrisonOdhran MurrayAli Nader-SepahiColin NnandiAnand PanditNitin PatelAnita PhilipMichael TC PoonKuskoor Seethram Manjunath PrasadSavva ProninShyam PujaraBalaji PurushothamanKapil RajwaniFahid Tariq RasulHolly RoyAhmed-Ramadan SadekMoritz SchrammGabrielle SciclunaPhilip J SellRoozbeh ShafafyHimanshu SharmaAsim SheikhVinothan SivasubramaniamAgbolahan SofelaGeorge SpinkNisaharan SrikandarajahPatrick FX StathamStuart StokesEuan StrachanChrishan ThakarGopiga ThanabalasundaramPaul ThorpeChristian UlbrichtAnna WattsAlison WhitcherDavid WhiteKathrin WhitehouseMartin WilbyJulie WoodfieldArdalan ZolnourianDepartment of Clinical Neurosciences, NHS Lothian, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Corresponding author. Centre for Clinical Brain Sciences, University of Edinburgh, 50 Little France Crescent, Edinburgh, EH16 4JA, UK.Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UKDepartment of Clinical Neurosciences, NHS Lothian, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UKKing's College Hospital, London, UK; Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UKInstitute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UKCentre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UKThe Walton Centre, Liverpool, UKSheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UKDepartment of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UKDepartment of Neurosurgery, Southmead Hospital, North Bristol NHS Trust, Bristol, UKDepartment of Orthopaedics, Royal Victoria Hospital, Belfast, UKSouthwest Neurosurgical Centre, Derriford Hospital, Plymouth, UK; University of Plymouth, Plymouth, UKDepartment of Clinical Neurosciences, NHS Lothian, Edinburgh, UKDepartment of Clinical Neurosciences, NHS Lothian, Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UKMusgrove Park Hospital, Taunton, UKThe Walton Centre, Liverpool, UKKing's College Hospital, London, UKDepartment of Clinical Neurosciences, NHS Lothian, Edinburgh, UKDepartment of Orthopaedics, Royal Victoria Hospital, Belfast, UKUniversity Hospitals of Leicester NHS Trust, Leicester, UKDepartment of Clinical Neurosciences, NHS Lothian, Edinburgh, UKSummary: 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.http://www.sciencedirect.com/science/article/pii/S2666776222002411Cauda equina syndromeBack painUrinary retentionCohort studySpinal surgery |
| spellingShingle | 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 Stacey Darwish Benjamin Davies Andreas K Demetriades Saurabh Deore Chris Derham Muhammad Dherijha Gareth Dobson James Duncan Andrew Durnford Alexander ZE Durst Edward W Dyson Niall Eames 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 Gordan Grahovac Rebecca Grenfell Awais Habeebullah Nikolaos Haliasos Tim Hammett Cathal John Hannan Ciaran Scott Hill Ingrid Hoeritzauer David Holmes Kismet Hossain-Ibrahim Laura Hughes Muhammad Hussain Shakir Hussain Ramez Ibrahim Aimun AB Jamjoom Bethan John Shabin Joshi Josephine Jung Oliver Kennion Muhammad Khan Adriana Klejnotowska Ashwin Kumaria Roberta LaCava Simon Lammy 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 Savva Pronin Shyam Pujara Balaji Purushothaman Kapil Rajwani Fahid Tariq Rasul Holly Roy Ahmed-Ramadan Sadek Moritz Schramm Gabrielle Scicluna Philip J Sell Roozbeh Shafafy Himanshu Sharma Asim Sheikh Vinothan Sivasubramaniam Agbolahan Sofela George Spink Nisaharan Srikandarajah Patrick FX Statham Stuart Stokes Euan Strachan Chrishan Thakar Gopiga Thanabalasundaram Paul Thorpe Christian Ulbricht Anna Watts Alison Whitcher David White Kathrin Whitehouse Martin Wilby Julie Woodfield Ardalan Zolnourian 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 The Lancet Regional Health. Europe Cauda equina syndrome Back pain Urinary retention Cohort study Spinal surgery |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Cauda equina syndrome Back pain Urinary retention Cohort study Spinal surgery |
| url | http://www.sciencedirect.com/science/article/pii/S2666776222002411 |
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