Understanding Cauda Equina Syndrome

Understanding Cauda Equina Syndrome (UCES) is a prospective cohort study of patients with confirmed CES managed at specialist spinal centres in the UK.

Cases will be identified by neurosurgical or orthopaedic trainees in each specialist centre through daily screening of tertiary referrals and admissions to specialist spinal services. All patients managed as CES by the treating team will be included in this audit. CES will be divided into CES suspected (CESS), CES incomplete (CESI), and CES retention (CESR).

Data regarding timing and type of symptom onset, referral, investigation, management, and outcome will be recorded anonymously on a secure database by the local trainee investigator during the patient's hospital admission and after discharge. Patient consent will be sought for the use of their data and patients will be asked to complete patient reported outcome measures representing their condition before surgery and up to one year after surgery. This data will be compared with care quality statements and published outcome data for CES.

The study will recruit for one year. Cases will be identified from admissions to spinal units between 1st June 2018 until 31st May 2019. The last one year follow up assessments will be sent to participants on 1st June 2020.

This is an observational study. No changes to routine patient care will occur during this study.

Inclusion criteria

• For inclusion in this study, the patient must:

• be over 18 years old;
• be admitted to a specialist spinal service in the UK between 1st June 2018 and 31st May 2019;
• have capacity to provide informed consent for participation in this study; and
• have a diagnosis of clinical CES and structural compression of the cauda equina on imaging as determined by the treating clinician.

• Clinical CES includes any disturbance of saddle sensation, bladder function, bowel function, sexual dysfunction and bilateral sciatica associated with radiological compression of the cauda equina. The cauda equina compression can be due to any cause, including, but not limited to, disc, tumour, infection, etc.

Exclusion criteria

• • Patients under 18 years old

• Patients undergoing emergent decompression for unilateral motor or sensory symptoms (eg foot drop), without clinical evidence of CES
• Patients referred with suspected CES where the diagnosis is not confirmed, for example:

o Patients with the clinical symptoms and signs of CES without radiological evidence of cauda equina compression

• Patients not admitted to participating spinal centres in the UK
• Patients admitted to a participating spinal centre before 1st June 2018 or after 31st May 2019
• Patients who are unable to provide informed consent for participation in this study