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Br J Neurosurg. 2016 Oct;30(5):518-22. doi: 10.1080/02688697.2016.1187254. Epub 2016 May 30.

Standards of care in cauda equina syndrome.

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a Sandyford , Newcastle upon Tyne , UK ;
b University of Leeds , Leeds , UK.


What constitutes cauda equina syndrome (CES), how it should be subclassified and how urgently to image and operate on patients with CES are all matters of debate. A structured review of the literature has led us to evaluate the science and to propose evidence-based guidelines for the management of CES. Our conclusions include this guidance: pain only; MRI negative - recommend: analgesia, ensure imaging complete (not just lumbar spine) adequate follow-up. Bilateral radiculopathy (CESS) with a large central disc prolapse - recommend: discuss with the patient and if for surgery, the next day (unless deteriorates to CESI in which case emergency surgery); CESI - recommend: the true emergency for surgery by day or night; a large central PLID with uncertainty as to whether CESI or CESR (e.g. catheterised prior to CESR) or where there is residual cauda equina nerve root function or early CESR - recommend: treat as an emergency by day or night. Where there has been prolonged CESR and/or no residual sacral nerve root function - recommend: treat on the following day's list.


CES; CESC; CESI; CESR; CESS; Cauda equina syndrome; standards of care

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