Incidence and long-term patient reported outcome measures of patients with radiological cauda equina compression but without clinical features of cauda equina syndrome.

IF 1.4 Q2 OTORHINOLARYNGOLOGY
Hamzah Alsheikh Soleiman, Mary Solou, Andreas K Demetriades
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引用次数: 0

Abstract

Background: Cauda equina syndrome (CES) is a rare spinal emergency. Paradoxically, in the British NHS, suspected CES requiring an emergency magnetic resonance imaging constitutes one of the commonest reasons for acute referrals to neurosurgery/spine surgery. Further acute referrals also occur with the reverse scenario, when radiological evidence of cauda equina compression is not accompanied by the clinical red flags of the syndrome. The understanding of CES, particularly in cases with radiological compression but lacking clinical symptoms, remains limited. This study aims to explore the incidence and the long-term outcomes of such patients, addressing a significant knowledge gap.

Methods: A single-center, retrospective and cohort study was conducted, analyzing suspected CES referrals managed between August 2013 and November 2014. Patients with radiological cauda equina compression but without clinical CES features were identified. A structured questionnaire assessed long-term patient reported outcomes.

Results: Out of 344 suspected CES referrals, 38 patients (11%) had radiological CES of degenerative cause without clinical symptoms. From those with radiological cauda equina compression but no features of CES, 14 were assessed for long-term results and the majority still underwent surgery (64%), either emergent (35.7%) or elective (28.6%). The long-term patient reported outcomes of the operated patients revealed that 66.7% were fully ambulant, 77.8% maintained an intact sexual function, and 88.9% were free of urinary symptoms. However, no matter the management, chronic pain persisted in 85.7%.

Conclusion: This study highlights the existence of patients who are referred urgently with radiological cauda equina compression but who lack clinical CES symptoms. Despite surgical interventions, chronic pain remains a significant issue. Further research, including multi-centered studies, is warranted to enhance our understanding of this condition and its nuanced subpopulations.

无马尾综合征临床特征的放射学马尾受压患者的发生率和长期患者报告的结果测量。
背景:马尾综合征(CES)是一种罕见的脊柱急症。矛盾的是,在英国国家医疗服务体系中,疑似CES需要紧急磁共振成像是急性转介到神经外科/脊柱外科的最常见原因之一。进一步的急性转诊也发生在相反的情况下,当马尾受压的放射证据没有伴随该综合征的临床危险信号时。对CES的了解仍然有限,特别是在有放射压迫但没有临床症状的病例中。本研究旨在探讨此类患者的发病率和长期预后,解决一个重要的知识缺口。方法:采用单中心、回顾性和队列研究,分析2013年8月至2014年11月期间管理的疑似CES转诊病例。确定了影像学上有马尾受压但无临床CES特征的患者。一个结构化的问卷评估长期患者报告的结果。结果:在344例疑似CES转诊患者中,38例(11%)有退行性CES,无临床症状。影像学上有马尾受压但无CES特征的患者中,有14例进行了长期结果评估,大多数仍接受了手术(64%),无论是急诊(35.7%)还是择期(28.6%)。手术患者的长期报告结果显示,66.7%的患者可以完全走动,77.8%的患者保持完整的性功能,88.9%的患者没有泌尿系统症状。然而,无论如何治疗,慢性疼痛持续存在的占85.7%。结论:本研究强调了因放射学马尾受压而紧急转诊但缺乏临床CES症状的患者的存在。尽管手术干预,慢性疼痛仍然是一个重要的问题。进一步的研究,包括多中心研究,有必要加强我们对这种情况及其细微差别的亚群的理解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.90
自引率
9.10%
发文量
57
审稿时长
12 weeks
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