Introduction: The NDI is a simple 10-item questionnaire used to assess patients with neck pain. The original validation was performed on 52 patients with neck pain and the test-retest on 17 whiplash patients with a 2-day interval. The SF36 measures functional ability, wellbeing and the overall health of patients. It is used in health economics to assess the health utility, gain and economic impact of medical interventions.

Objectives: (1) Independently validate the NDI in patients with neck pain. (2) Draw comparison of the NDI and SF36.

Subjects: 100 patients with neck pain attending the spinal clinic completed self-assessment questionnaires. A second questionnaire was completed in 30 patients after a period of 1–2 weeks.

Statistics: The internal consistency of the NDI and SF36 was calculated using Cronbach alpha. The test-retest reliability and the concurrent validity between the two questionnaire scores were assessed using Pearson correlation. Individual scores for each of the ten items of the NDI were correlated to the total disability score categories.

Results: Both questionnaires showed robust internal consistency – alpha for NDI = 0.85 (95% CI = 0.8–0.89) and SF36 = 0.84 (95% CI = 0.79–0.88). The NDI had significant correlation to all eight domains of the SF36 (p< 0.001). The individual scores for each of the ten items had significant correlation with the total disability score (p< 0.001). The test-retest reliability of the NDI was acceptable.

Conclusions: We have shown irrefutably that the NDI has good reliability and validity and that it stands up well to the SF36.

Introduction: To determine the factors which influence outcome after surgery for cauda equina syndrome.

Method: 56 patients with evidence of sphincteric disturbance who underwent urgent surgery between 1994 and 2002 were identified and invited to follow up. Outcomes consisted of history and examination, and several validated questionnaires.

Results: 42 patients attended with a mean follow up of 60 months (range 25–114). Mean age at onset was 41 years (range 24–67) with 23 males and 19 females. 26 patients were operated on within 48 hours of onset. Urinary disturbance at presentation did not affect the outcomes. Bowel disturbance at presentation was associated with sexual problems (< 0.005) and abnormal rectal tone (p< 0.05) at follow up. There was a weak association between delay to operation and bowel disturbance (p< 0.05) at follow up. Eight patients had faecal soiling and faecal incontinence at follow up and this was associated with sudden onset of symptoms, initial abnormal rectal tone and time to operation (p< 0.05). The 12 patients who failed their postoperative trial without catheter had worse outcomes. The SF36 scores at follow up were reduced compared to age matched norms in the population. The mean ODI was 29, LBOS 42 and VAS 4.5.

Discussion: In our series the duration of symptoms and speed of onset prior to surgery appears to influence bowel but not bladder outcome two years after surgery. Based on the SF36, LBOS and ODI scores, patients who have had CES do not return to a normal status.

Objective: To determine the factors which influence outcome after surgery for cauda equina syndrome. Particular attention has been given to sphincteric recovery.

Study Design: Retrospective cohort study with prospective clinical follow up.

Subjects: 56 patients with evidence of a sphincteric disturbance who underwent urgent surgery between 1994 and 2002 were identified and invited for follow up.

Outcome Measures: History and examination, Oswestry Disability Index, Short Form 36 Health Survey Questionnaire, Visual Analogue Score, Low Back Outcome Score, Modified Somatic Perception Score, Modified Zung Depression Score, International Prostate Severity Score, Male Sexual Health Questionnaire and Sheffield Female Pelvic Floor Questionnaire.

Results: 42 patients attended with a mean follow up of 60 months (Range 25–114 months). Mean age at onset was 41 years (Range 24–67 years) with 23 males and 19 females. 25 patients had sudden onset of symptoms in less than 24 hours. 26 patients were operated on within 48 hours of onset. At presentation urinary retention was associated with acute onset of less than 24 hours (p< 0.01), leg weakness (p< 0.01), abnormal leg sensation (p< 0.05) and abnormal rectal tone (p< 0.05). Bilateral radiculopathy was associated with leg weakness (p< 0.005). All patients with abnormal rectal tone (21) had abnormal rectal sensation.

At follow up significantly more females had urinary incontinence (p< 0.001) and bowel disturbance (p< 0.05), higher VAS scores (p< 0.05) and lower SF36 Pain and Energy scores (p< 0.05) than males. Urinary disturbance at presentation did not affect the outcomes. Bowel disturbance at presentation was associated with sexual problems (< 0.005) and abnormal rectal tone (p< 0.05) at follow up. Objective reduced perianal sensation at onset persisted in a significant number at follow up (21/32 patients; p< 0.05) as did leg weakness (14/23; p< 0.005). There was a weak association between delay to operation and bowel disturbance (p< 0.05) at follow up. Eight patients had faecal soiling and faecal incontinence at follow up and this was associated with sudden onset of symptoms, initial abnormal rectal tone and time to operation (p< 0.05). The SF36 scores at follow up were reduced compared to age matched norms in the population. The mean ODI was 29, LBOS 42 and VAS 4.5.

Conclusions: In our series the duration of symptoms and speed of onset prior to surgery appears to influence bowel but not bladder outcome two years after surgery. Based on the SF36, LBOS and ODI scores, patients who have had CES do not return to a normal status. Patient counselling about this would therefore be appropriate.