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Imaging in cauda equina syndrome--a pictorial review.

McNamee J, Flynn P, O'Leary S, Love M, Kelly B - Ulster Med J (2013)

View Article: PubMed Central - PubMed

Affiliation: Imaging Centre, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA.

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Cauda Equina Syndrome (CES) is an uncommon condition that is important because of its catastrophic consequences for the patient and its potential for medico-legal actions against medical staff... CES results from dysfunction of the sacral and lumbar nerve roots in the vertebral canal producing impairment of bladder, bowel or sexual function and perianal or saddle numbness... Most authors advocate emergency surgical decompression to improve outcomes in CES, however there is controversy with regard to the timing of surgery... Although the majority of authors advocate early surgery within 24 hours to improve functional outcome, several authors have shown little benefit to patients with complete cauda equina syndrome and early operative intervention... Shapiro retrospectively reviewed 44 patients with CES... In another meta-analysis, Hussain et al reported on 20 CES patients... Their study did not show any reduction in permanent disability between the group performed within 5 hours (9 patients ) and those (11 patients) between 8–24 hours... While there is debate about the exact timing of surgery in the literature, the consensus view is that those with incomplete cauda equina syndrome or indeterminate cases should be decompressed immediately as their neurologic and urologic outcomes are clearly improved if the patient does not progress to complete cauda equina syndrome... We advocate the definition, as proposed by Fraser et al, that CES results from dysfunction of the sacral and lumbar nerve roots within the vertebral canal producing impairment of bladder, bowel or sexual function and perianal or saddle numbness... We recommend the nomenclature and classification as recommended by the combined task forces of North American Spine Society, American Society of Spine Radiology and American Society of Neuroradiology... Early surgical decompression is advocated by most authors to best aid patient recovery and reduce long term disability... There is evidence to suggest intervention within 24 hours significantly improves outcomes.

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Sagittal T2WI shows a compression fracture of L3 with retropulsion of the posterior aspect of the vertebral body into the spinal canal. There is a convex area of low signal posterior to the L2 and L3 vertebral bodies that is compressing the adjacent nerve roots. The findings are consistent with a compression fracture of L3 with an associated extradural haematoma.
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fig18: Sagittal T2WI shows a compression fracture of L3 with retropulsion of the posterior aspect of the vertebral body into the spinal canal. There is a convex area of low signal posterior to the L2 and L3 vertebral bodies that is compressing the adjacent nerve roots. The findings are consistent with a compression fracture of L3 with an associated extradural haematoma.

Mentions: A 79-year old man presents with increasing leg weakness following a fall. On warfarin for atrial fibrillation. (figure 11)Fig 11


Imaging in cauda equina syndrome--a pictorial review.

McNamee J, Flynn P, O'Leary S, Love M, Kelly B - Ulster Med J (2013)

Sagittal T2WI shows a compression fracture of L3 with retropulsion of the posterior aspect of the vertebral body into the spinal canal. There is a convex area of low signal posterior to the L2 and L3 vertebral bodies that is compressing the adjacent nerve roots. The findings are consistent with a compression fracture of L3 with an associated extradural haematoma.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3756868&req=5

fig18: Sagittal T2WI shows a compression fracture of L3 with retropulsion of the posterior aspect of the vertebral body into the spinal canal. There is a convex area of low signal posterior to the L2 and L3 vertebral bodies that is compressing the adjacent nerve roots. The findings are consistent with a compression fracture of L3 with an associated extradural haematoma.
Mentions: A 79-year old man presents with increasing leg weakness following a fall. On warfarin for atrial fibrillation. (figure 11)Fig 11

View Article: PubMed Central - PubMed

Affiliation: Imaging Centre, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Cauda Equina Syndrome (CES) is an uncommon condition that is important because of its catastrophic consequences for the patient and its potential for medico-legal actions against medical staff... CES results from dysfunction of the sacral and lumbar nerve roots in the vertebral canal producing impairment of bladder, bowel or sexual function and perianal or saddle numbness... Most authors advocate emergency surgical decompression to improve outcomes in CES, however there is controversy with regard to the timing of surgery... Although the majority of authors advocate early surgery within 24 hours to improve functional outcome, several authors have shown little benefit to patients with complete cauda equina syndrome and early operative intervention... Shapiro retrospectively reviewed 44 patients with CES... In another meta-analysis, Hussain et al reported on 20 CES patients... Their study did not show any reduction in permanent disability between the group performed within 5 hours (9 patients ) and those (11 patients) between 8–24 hours... While there is debate about the exact timing of surgery in the literature, the consensus view is that those with incomplete cauda equina syndrome or indeterminate cases should be decompressed immediately as their neurologic and urologic outcomes are clearly improved if the patient does not progress to complete cauda equina syndrome... We advocate the definition, as proposed by Fraser et al, that CES results from dysfunction of the sacral and lumbar nerve roots within the vertebral canal producing impairment of bladder, bowel or sexual function and perianal or saddle numbness... We recommend the nomenclature and classification as recommended by the combined task forces of North American Spine Society, American Society of Spine Radiology and American Society of Neuroradiology... Early surgical decompression is advocated by most authors to best aid patient recovery and reduce long term disability... There is evidence to suggest intervention within 24 hours significantly improves outcomes.

Show MeSH
Related in: MedlinePlus