Pitfalls in spotting cauda equina syndrome

Image credit: Science Photo Library

By Dr Guy Krauth

CAUDA Equina Syndrome (CES) is a relatively uncommon condition. However, it does have an annual incidence of around seven per 100,000 patients of working age and therefore a typical GP might expect to see one case of confirmed CES every four to five years.

A missed or delayed diagnosis of CES can have catastrophic outcomes for the patient and very real medicolegal consequences for the clinicians involved. It is therefore essential that trainees in emergency medicine and orthopaedic surgery, as well as GPs are able to recognise the cardinal features of CES and ensure that referral and appropriate MRI scanning is undertaken in a timely manner.

Critical window

It is important for clinicians to recognise that early (ECES) or incomplete (ICES) cases may present without the full array of classic CES symptoms. In patients with ECES/ICES, there is a time-critical window of opportunity in which to intervene in order to preserve bladder/bowel and sexual function. Once the patient progresses to complete CES, the odds of a full recovery after surgery are reduced.