CES

Question 1

What is CES?

Answer 1

Compressive injury to the cauda equina nerve roots L2-S5 nerve roots results in a constitution of symptoms including motor and sensory deficits aswell as bladder, bowel and sexual dysfunction.

Question 2

What is the cauda equina?

Answer 2

Bundle of L2-S5 Nerve roots, continuation of the spinal cord

Question 3

How would you examine

Answer 3

Focus history and examination:

Onset of symptoms
Trauma, lifting heavy object
Radicular pain
Urinary function
Bowel function
Sexual Function
Malignancy symptoms
Weakness in legs
Numbess in wiping bottom

Examination:
Full lower neurological (sensation, power, reflexs) + spinal examination
Babinski reflex and SLR
PR and PVBS
Asia CHART.

Relevant blood test:
FBC, U&Es, CRP, Ca

Imaging:
Rule out Fracture

Question 4

How can we classify CES?

Answer 4

CES-I (incomplete): have not yet developed urinary retention and have better clinical outcomes (40% of patients)

CES-R (retention): have developed urinary retention and have worse clinical outcomes (60% of patients)

Question 5

What are the causes of cauda equina syndrome?

Answer 5

Disc Prolapse
Tumour
Fracture
Epidural Abcess
Haematoma

Question 6

What are the aims in terms of timing for CES MRI and decompression?

Answer 6

MRI < 4 hrs GRIFT Guidance
Surgical Decompression < 48hrs

Question 7

What are the red flag symptoms of back pain?

Answer 7

Thoracic pain.
Fever and unexplained weight loss.
Radicular pain
Bladder or bowel dysfunction.
History of carcinoma.
Ill health or presence of other medical illness.
Progressive neurological deficit.
Disturbed gait, saddle anaesthesia.
Age of onset <20 years or >55 years.

Question 8

What is the significance of a PVBS?

Answer 8

PVBS > 200ml makes the diagnosis of CES 20x more likley.

Question 9

What are the 3 columns of the spine?

Answer 9

The anterior column is made up of the anterior longitudinal ligament and anterior half of the vertebral body and disc

The middle column comprises the posterior half of the vertebral body and disc, and the posterior longitudinal ligament

The posterior column is made up of the facet joints, ligamentum flavum, the posterior elements and the interconnecting ligaments

Question 10

What would you like to do before sending this patient for urgent decompression?

Answer 10

• Ensure paperwork is documented.
• Appropriate pre-operative investigations have been carried out.