Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: A multi-centre prospective cohort study
Published research co-authored by Mr Gordan Grahovac
This large prospective cohort study examined how cauda equina syndrome presents, is managed and affects patients up to one year after surgery. It is important because CES is uncommon but serious, and standardised outcome data are limited.
Research snapshot
Article 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 study
Authors: Julie Woodfield, Ingrid Hoeritzauer, Aimun A B Jamjoom, Josephine Jung, Simon Lammy, Savva Pronin, Cathal John Hannan, Anna L Watts, Laura Hughes, Richard D C Moon, Stacey Darwish, Holly A 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, UCES Collaborators, British Neurosurgical Trainee Research Collaborative
Publication type: Journal article
Publication date: 17 November 2022
Publication details: The Lancet Regional Health - Europe. 2023;24:100545.
PMID: 36426378
PMCID: PMC9678980
DOI: 10.1016/j.lanepe.2022.100545
Study type: Prospective multicentre observational cohort study
Mr Grahovac’s involvement: Listed author on the publication
Original publication: View the original publication on PubMed
What this paper looked at
This study investigated adults with cauda equina syndrome across multiple centres in the UK. It assessed presentation, investigation, management and outcomes up to one year after surgery using clinician and participant reporting.
Key points from the publication
The study included 621 participants with cauda equina syndrome. Indexed records report that urinary retention requiring catheterisation was common before surgery and reduced by discharge, with outcomes assessed across core domains up to one year.
Clinical relevance
The paper is highly relevant to diagnosis, patient counselling, outcome measurement and service planning for cauda equina syndrome. It highlights that recovery and ongoing symptoms can be complex and should be assessed beyond the immediate operation.
What this means in context
This research supports more informed understanding of cauda equina syndrome, but it is not individual medical advice. Decisions depend on symptoms, neurological examination, bladder and bowel function, MRI findings, timing, urgency and specialist assessment.
View published abstract
The following abstract is reproduced from the original publication and is provided for reference. It may include technical terminology intended for clinical or academic audiences.
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.
Keywords: Back pain; Cauda equina syndrome; Cohort study; Spinal surgery; Urinary retention.
View the original publication on PubMed
About Mr Gordan Grahovac
Mr Gordan Grahovac is a Consultant Neurosurgeon and Complex Spinal Surgeon with expertise in managing complex spinal and neurosurgical conditions.
His work includes the assessment and treatment of patients with degenerative spinal conditions, spinal cord compression, spinal tumours, complex spinal pathology and conditions requiring specialist neurosurgical input.
His approach focuses on careful diagnosis, appropriate treatment planning and helping patients understand their options clearly.
Important note
This page is for educational purposes only and should not be taken as individual medical advice.
If you or someone you know has symptoms such as worsening headache, confusion, drowsiness, weakness, changes in speech, seizures, balance problems or symptoms following a head injury, seek urgent medical advice.
