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Cauda Equina Syndrome: An Audit. Can We Do Better?

Abstract Background: Cauda equina syndrome (CES) is a relatively uncommon but serious complex of disorders that can progress to paraplegia with permanent bowel and bladder incontinence. Early recognition of CES with immediate surgical decompression of the cauda equina is believed to result in a better clinical outcome than delayed surgical decompression. Aim: To determine the time taken between the onset of symptoms in CES and surgical decompression and describe the factors responsible for any delay before surgery. Design of study and settings: The British Association Of Spinal Surgeons (BASS) conducted a national survey to investigate the time interval between the onset of symptoms of CES and surgical decompression. Methods: Data collection forms were circulated to both orthopaedic spine surgeons and neurosurgeons. Results: 45 cases of CES requiring surgical decompression were reported. The average delay between symptom onset and contact with general practitioner(GP) was 58 hours (0–336). The mean duration between initial GP consultations to specialist referral was 128 hours (0–2400). The mean delay from MRI scan to surgery was 67 hours (0–500). Conclusion: There is considerable room for improvement in the management of CES. More rapid recognition of the significance of presenting symptoms by patients and GPs, and faster surgical decompression after MRI scanning is desirable.