Abstract
Purpose: Cauda Equina Syndrome (CES) is a frequently cited red flag in patients presenting with back pain and is considered a surgical emergency. The purpose of this paper is to review the current literature on CES, to establish consensus on its definition, clinical presentation and possible aetiology.
Methods: The databases (Medline 1951 →, Embase 1974 →, Cinhal 1982 →) were searched using the key words Cauda Equina Syndrome and:
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Definition,
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Clinical presentation
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Signs and Symptoms
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Pathology
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Aetiology
The findings from these searches were coded to identify individual aspects of CES. The consistency of each aspect was then classified using The Guidelines Development Groups format (where 100% coverage = ‘unanimity’; 75–99% = ‘consensus’; 51–74% = ‘majority view’; and 0– 50% = ‘no consensus’), and the findings summarized.
Results: The electronic searches revealed 104 papers comprising case reports, case studies, literature reviews, expert opinion and papers based on clinical experience.
From these, there were widely varying descriptions of the definition, clinical presentation and aetiology of CES, and no individual aspects reached 100% agreement. The individual aspect with greatest agreement was found to be bladder dysfunction.
Conclusion: Cauda Equina Syndrome is considered a discrete clinical entity; however there is inconsistency within the literature as to its definition, clinical presentation and aetiology. To document its prevalence, clarity in definition is needed. Identifying this surgical emergency is paramount for all those who undertake spinal assessments.
Correspondence should be addressed to: Mr John O’ Dowd, SBPR, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
