Original Article

Characteristics and clinical features of cauda equina syndrome: insights from a study on 256 patients

¹ Registrar Trauma and Orthopaedics, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, United Kingdom
² Associate Specialist, Trauma and Orthopaedics, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, United Kingdom
³ SHO Trauma and Orthopaedics, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, United Kingdom
⁴ Clinical Attachment Trauma and Orthopedics, Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Pensnett Rd, Dudley DY1 2HQ, United Kingdom

^* Corresponding author: jzshah75@gmail.com

Received: 9 May 2023
Accepted: 23 June 2023

Abstract

Objective: To determine the frequency, clinical presentation, and etiological factors of cauda equina syndrome (CES). Materials and method: This retrospective study was done on 256 participants, and aimed to analyze the frequency and patterns of clinical presentation in suspected cases of CES. The inclusion criteria included participants aged 18 or older with medical records available for review and having red-flagged symptoms for CES. The study collected information on various factors such as age, gender, confirmation of CES on MRI, neurological deficits, etiological factors, duration of symptoms, and more. The data collected was analyzed using descriptive statistics and logistic regression to identify significant variables between MRI-proven CES and suspected CES. Results: The mean age was 58.05 ± 19.26 years, with 151 females (58.98%) and 105 males (41.02%). The majority (50.78%) had a neurological deficit, while other symptoms included difficulty initiating micturition or impaired sensation of urinary flow (17.58%), loss of sensation of rectal fullness (3.12%), urinary or faecal incontinence (35.16%), bilateral sciatica (21.88%), neurological symptoms in the lower limbs (25.00%), anaesthesia or any leg weakness (24.22%), and bilateral sciatica as the predominant symptom (21.88%). Symptoms were chronic in 47.27% and acute in 21.88%. The odds of MRI-proven CES increase by 3% per year of age. Neurological deficit was strongly associated with MRI-proven CES (OR = 14.97), while loss of sensation of rectal fullness increased the odds by 10-fold (OR = 10.62). Conclusion: CES can present with various symptoms, including the bilateral neurological deficit, urinary and faecal incontinence, and bilateral sciatica, with age, severe bilateral neurological deficit, and loss of sensation of rectal fullness being associated with MRI-proven CES. Early diagnosis and treatment are crucial for better outcomes.