Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study

Julie Woodfield; Ingrid Hoeritzauer; Aimun A.B. Jamjoom; Josephine Jung; Simon Lammy; Savva Pronin; Cathal J. Hannan; Anna Watts; Laura Hughes; Richard D.C. Moon; Stacey Darwish; Holly Roy; Phillip C. Copley; Michael T.C. Poon; Paul Thorpe; Nisaharan Srikandarajah; Gordan Grahovac; Andreas K. Demetriades; Niall Eames; Philip J. Sell; Patrick F.X. Statham; Mohamed Abdelsadg; Motaz MS Abulaila; Usman Ahmed; Qasim Ajmi; Rafid Al-Mahfoudh; Chadi Ali; Meriem Amarouche; Amin Andalib; M Arora; M Arora; Mariam Awan; Mirza A Baig; Antony Bateman; Iwan Bennett; Imran Bhatti; Peter Bodkin; Lalasa Bommireddy; George Bonanos; Anouk Borg; Alexandros Boukas; James Bourne; Rachael Brennan; J Brown; K Brown; Oliver Burton; Christopher Busby; Neil Chiverton; Simon Clark; Phillip C. Copley; S Cudlip; Y Cunningham; R Dardis; Stacey Darwish; B Davies; Andreas K. Demetriades; S Deore; C Derham; M Dherijha; G Dobson; J Duncan; A Durnford; AZE Durst; EW Dyson; Niall Eames; Ellie Edlmann; A Edwards-Bailey; A Elserius; B Elson; M Fadelalla; DM Fountain; A Gardner; A Ghosh; JR Gill; SA Glasmacher; R Gordon; Gordan Grahovac; R Grenfell; A Habeebullah; N Haliasos; T Hammett; Cathal J. Hannan; CS Hill; Ingrid Hoeritzauer; D Holmes; K Hossain-Ibrahim; Laura Hughes; M Hussain; S Hussain; R Ibrahim

doi:10.1016/j.lanepe.2022.100545

Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study

Julie Woodfield^*
, Ingrid Hoeritzauer
, Aimun A.B. Jamjoom
, Josephine Jung
, Simon Lammy
, Savva Pronin
, Cathal J. Hannan
, Anna Watts
, Laura Hughes
, Richard D.C. Moon
, Stacey Darwish
, Holly Roy
, Phillip C. Copley
, Michael T.C. Poon
, Paul Thorpe
, Nisaharan Srikandarajah
, Gordan Grahovac
, Andreas K. Demetriades
, Niall Eames
, Philip J. Sell

Patrick F.X. Statham, Mohamed Abdelsadg, Motaz MS Abulaila, Usman Ahmed, Qasim Ajmi, Rafid Al-Mahfoudh, Chadi Ali, Meriem Amarouche, Amin Andalib, M Arora, M Arora, Mariam Awan, Mirza A Baig, Antony Bateman, Iwan Bennett, Imran Bhatti, Peter Bodkin, Lalasa Bommireddy, George Bonanos, Anouk Borg, Alexandros Boukas, James Bourne, Rachael Brennan, J Brown, K Brown, Oliver Burton, Christopher Busby, Neil Chiverton, Simon Clark, Phillip C. Copley, S Cudlip, Y Cunningham, R Dardis, Stacey Darwish, B Davies, Andreas K. Demetriades, S Deore, C Derham, M Dherijha, G Dobson, J Duncan, A Durnford, AZE Durst, EW Dyson, Niall Eames, Ellie Edlmann, A Edwards-Bailey, A Elserius, B Elson, M Fadelalla, DM Fountain, A Gardner, A Ghosh, JR Gill, SA Glasmacher, R Gordon, Gordan Grahovac, R Grenfell, A Habeebullah, N Haliasos, T Hammett, Cathal J. Hannan, CS Hill, Ingrid Hoeritzauer, D Holmes, K Hossain-Ibrahim, Laura Hughes, M Hussain, S Hussain, R Ibrahim

^*Corresponding author for this work

Peninsula Medical School

NHS Lothian
University of Edinburgh
NHS Grampian
Kings College London
Queen Elizabeth University Hospital, Glasgow
The Walton Centre NHS Foundation Trust
Sheffield Teaching Hospitals NHS Foundation Trust
Southmead Hospital NHS Trust
Royal Victoria Hospital Belfast
University Hospitals Plymouth NHS Trust
Somerset NHS Foundation Trust
University Hospitals of Leicester NHS Trust

Research output: Contribution to journal › Article › peer-review

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Abstract

Background
Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures.
Methods
This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated.
Findings
In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up.
Interpretation
Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively.
Funding
DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.

Original language	English
Article number	100545
Journal	The Lancet Regional Health - Europe
Volume	24
Early online date	17 Nov 2022
DOIs	https://doi.org/10.1016/j.lanepe.2022.100545
Publication status	Published - Jan 2023

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Woodfield, J., Hoeritzauer, I., Jamjoom, A. A. B., Jung, J., Lammy, S., Pronin, S., Hannan, C. J., Watts, A., Hughes, L., Moon, R. D. C., Darwish, S., Roy, H., Copley, P. C., Poon, M. T. C., Thorpe, P., Srikandarajah, N., Grahovac, G., Demetriades, A. K., Eames, N., ... Ibrahim, R. (2023). Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study. The Lancet Regional Health - Europe, 24, Article 100545. https://doi.org/10.1016/j.lanepe.2022.100545

@article{471a8c17c2dd492480988ffd6446d237,

title = "Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study",

abstract = "Background Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31\% (191/615). At discharge, only 13\% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1{\textendash}8) with 32\% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95\%CI:1.5{\textendash}3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95\%CI:5.8{\textendash}20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95\%CI:0.2{\textendash}0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65\% (320/490) during one year follow up. Interpretation Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.",

author = "Julie Woodfield and Ingrid Hoeritzauer and Jamjoom, \{Aimun A.B.\} and Josephine Jung and Simon Lammy and Savva Pronin and Hannan, \{Cathal J.\} and Anna Watts and Laura Hughes and Moon, \{Richard D.C.\} and Stacey Darwish and Holly Roy and Copley, \{Phillip C.\} and Poon, \{Michael T.C.\} and Paul Thorpe and Nisaharan Srikandarajah and Gordan Grahovac and Demetriades, \{Andreas K.\} and Niall Eames and Sell, \{Philip J.\} and Statham, \{Patrick F.X.\} and Mohamed Abdelsadg and Abulaila, \{Motaz MS\} and Usman Ahmed and Qasim Ajmi and Rafid Al-Mahfoudh and Chadi Ali and Meriem Amarouche and Amin Andalib and M Arora and M Arora and Mariam Awan and Baig, \{Mirza A\} and Antony Bateman and Iwan Bennett and Imran Bhatti and Peter Bodkin and Lalasa Bommireddy and George Bonanos and Anouk Borg and Alexandros Boukas and James Bourne and Rachael Brennan and J Brown and K Brown and Oliver Burton and Christopher Busby and Neil Chiverton and Simon Clark and Copley, \{Phillip C.\} and S Cudlip and Y Cunningham and R Dardis and Stacey Darwish and B Davies and Demetriades, \{Andreas K.\} and S Deore and C Derham and M Dherijha and G Dobson and J Duncan and A Durnford and AZE Durst and EW Dyson and Niall Eames and Ellie Edlmann and A Edwards-Bailey and A Elserius and B Elson and M Fadelalla and DM Fountain and A Gardner and A Ghosh and JR Gill and SA Glasmacher and R Gordon and Gordan Grahovac and R Grenfell and A Habeebullah and N Haliasos and T Hammett and Hannan, \{Cathal J.\} and CS Hill and Ingrid Hoeritzauer and D Holmes and K Hossain-Ibrahim and Laura Hughes and M Hussain and S Hussain and R Ibrahim",

year = "2023",

month = jan,

doi = "10.1016/j.lanepe.2022.100545",

language = "English",

volume = "24",

journal = "The Lancet Regional Health - Europe",

issn = "2666-7762",

publisher = "Elsevier Ltd.",

}

Woodfield, J, Hoeritzauer, I, Jamjoom, AAB, Jung, J, Lammy, S, Pronin, S, Hannan, CJ, Watts, A, Hughes, L, Moon, RDC, Darwish, S, Roy, H, Copley, PC, Poon, MTC, Thorpe, P, Srikandarajah, N, Grahovac, G, Demetriades, AK, Eames, N, Sell, PJ, Statham, PFX, Abdelsadg, M, Abulaila, MMS, Ahmed, U, Ajmi, Q, Al-Mahfoudh, R, Ali, C, Amarouche, M, Andalib, A, Arora, M, Arora, M, Awan, M, Baig, MA, Bateman, A, Bennett, I, Bhatti, I, Bodkin, P, Bommireddy, L, Bonanos, G, Borg, A, Boukas, A, Bourne, J, Brennan, R, Brown, J, Brown, K, Burton, O, Busby, C, Chiverton, N, Clark, S, Copley, PC, Cudlip, S, Cunningham, Y, Dardis, R, Darwish, S, Davies, B, Demetriades, AK, Deore, S, Derham, C, Dherijha, M, Dobson, G, Duncan, J, Durnford, A, Durst, AZE, Dyson, EW, Eames, N, Edlmann, E, Edwards-Bailey, A, Elserius, A, Elson, B, Fadelalla, M, Fountain, DM, Gardner, A, Ghosh, A, Gill, JR, Glasmacher, SA, Gordon, R, Grahovac, G, Grenfell, R, Habeebullah, A, Haliasos, N, Hammett, T, Hannan, CJ, Hill, CS, Hoeritzauer, I, Holmes, D, Hossain-Ibrahim, K, Hughes, L, Hussain, M, Hussain, S & Ibrahim, R 2023, 'Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study', The Lancet Regional Health - Europe, vol. 24, 100545. https://doi.org/10.1016/j.lanepe.2022.100545

Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study. / Woodfield, Julie; Hoeritzauer, Ingrid; Jamjoom, Aimun A.B. et al.
In: The Lancet Regional Health - Europe, Vol. 24, 100545, 01.2023.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study

AU - Woodfield, Julie

AU - Hoeritzauer, Ingrid

AU - Jamjoom, Aimun A.B.

AU - Jung, Josephine

AU - Lammy, Simon

AU - Pronin, Savva

AU - Hannan, Cathal J.

AU - Watts, Anna

AU - Hughes, Laura

AU - Moon, Richard D.C.

AU - Darwish, Stacey

AU - Roy, Holly

AU - Copley, Phillip C.

AU - Poon, Michael T.C.

AU - Thorpe, Paul

AU - Srikandarajah, Nisaharan

AU - Grahovac, Gordan

AU - Demetriades, Andreas K.

AU - Eames, Niall

AU - Sell, Philip J.

AU - Statham, Patrick F.X.

AU - Abdelsadg, Mohamed

AU - Abulaila, Motaz MS

AU - Ahmed, Usman

AU - Ajmi, Qasim

AU - Al-Mahfoudh, Rafid

AU - Ali, Chadi

AU - Amarouche, Meriem

AU - Andalib, Amin

AU - Arora, M

AU - Awan, Mariam

AU - Baig, Mirza A

AU - Bateman, Antony

AU - Bennett, Iwan

AU - Bhatti, Imran

AU - Bodkin, Peter

AU - Bommireddy, Lalasa

AU - Bonanos, George

AU - Borg, Anouk

AU - Boukas, Alexandros

AU - Bourne, James

AU - Brennan, Rachael

AU - Brown, J

AU - Brown, K

AU - Burton, Oliver

AU - Busby, Christopher

AU - Chiverton, Neil

AU - Clark, Simon

AU - Copley, Phillip C.

AU - Cudlip, S

AU - Cunningham, Y

AU - Dardis, R

AU - Darwish, Stacey

AU - Davies, B

AU - Demetriades, Andreas K.

AU - Deore, S

AU - Derham, C

AU - Dherijha, M

AU - Dobson, G

AU - Duncan, J

AU - Durnford, A

AU - Durst, AZE

AU - Dyson, EW

AU - Eames, Niall

AU - Edlmann, Ellie

AU - Edwards-Bailey, A

AU - Elserius, A

AU - Elson, B

AU - Fadelalla, M

AU - Fountain, DM

AU - Gardner, A

AU - Ghosh, A

AU - Gill, JR

AU - Glasmacher, SA

AU - Gordon, R

AU - Grahovac, Gordan

AU - Grenfell, R

AU - Habeebullah, A

AU - Haliasos, N

AU - Hammett, T

AU - Hannan, Cathal J.

AU - Hill, CS

AU - Hoeritzauer, Ingrid

AU - Holmes, D

AU - Hossain-Ibrahim, K

AU - Hughes, Laura

AU - Hussain, M

AU - Hussain, S

AU - Ibrahim, R

PY - 2023/1

Y1 - 2023/1

N2 - Background Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Interpretation Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.

AB - Background Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Interpretation Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.

UR - https://pearl.plymouth.ac.uk/pms-research/584/

U2 - 10.1016/j.lanepe.2022.100545

DO - 10.1016/j.lanepe.2022.100545

M3 - Article

SN - 2666-7762

VL - 24

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 100545

ER -

Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study

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