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Cauda equina syndrome – a surgical emergency

Cauda equina syndrome – a surgical emergency

core decline is rare but it can have life-changing consequences for patients if not acted upon in a timely manner even though I’ve been told what symptoms to look out for you don’t expect from having a bad back or even fit to slip this – you know having the possibility of it being a permanent situation you don’t expect you always expect when you’ve got bad back – and to get better the cauda equina provides innovation to the lower limbs and the sphincter it controls the function of the blood and bowel and sensation to the skin around the back passage and the bottom the most common cause of cauda equina syndrome is a prolapsed disc of the lumbar spine but other conditions such as spinal stenosis metastatic spinal cord compression can also cause cauda equina syndrome there is no agrees destination of cauda equina syndrome but the British Association of spinal surgeons present a definition that’s clinically useful a patient presenting with acute back pain and or leg pain with a suggestion of a disturbance of their bladder and bowel and or saddle sensory disturbance should be suspected of having called a coin syndrome we know that most of these patients will not have a critical corner coin of compression but in the absence of reliable predictive signs and symptoms which have scan these patients urgently give advice to anybody I think we’ve gotta be as genuine and as forthcoming as possible so if somebody asks you a question that you think you might be embarrassed about I don’t think embarrassment comes in – it is your therapists have taken on more and more extended scope roles as part of that we’ve taken on increased accountability and responsibility for our patients we have a duty of care to our patients to manage them safely and effectively there are increasing numbers of negligence claims going through related to cord required syndrome and these are increasingly involving physiotherapists what’s really important though is that this is about the patient so these called recliner claims are not just compensation claims planes have devastating effects on people’s lives I have to say it was a privilege to lead this qualitative study investigating patients experience of developing core equina syndrome to understand their story and these powerful experiences these patients have had you don’t expect to end up in a wheelchair you don’t expect to end up and with the obliged on your bow at working you don’t expect to end up and no and you don’t expect to end up in permanent pain problem was the effects I’ve had prior to surgery I was expecting those to be rectified to the table in the surgery I wasn’t aware that the damage that I’ve been caused because I’ve been caught soon enough was going to be either semi-permanent or a vanilla now permanent a key theme was that communication is so important in the context of severe pain these patients didn’t often recognize subtle and vague symptoms such as saddle numbness or early bladder symptoms in the context of severe pain equally it was very difficult to concentrate on the questions that they were being asked the questions didn’t have any face value what does my bladder function got to do with a severe back pain I was asked by the GPS and I was a resentencing wrong with my bladder I didn’t I didn’t know why they were asking these questions but they did ask similar symptoms all describing pain leg pain and bladder and bowel symptoms may be stubble anesthesia and not always fill the necessary for a diagnosis of court required syndrome but they came on in different orders and this is also important to recognize but all experience back pain at some points in the life they recognized that this was different none of them recognized how serious this was that outcomes could be poor in fact life-changing and that medical advice needed to be sought immediately no Bailey tells you it can be permanent ever all patients were keen that we helped further clinicians to identify these patients early that nobody suffered unduly it was interesting to hear what they came up with they wanted something like a cue card in their consultation something that would frame the questions as being important something that would help the clinician to understand that this is going to be a very important part of the consultation the patient needed to understand these questions are so important for us to understand I have to Google quarterfinal when and I saw Manila following my surgery has called a crime syndrome on it can imagine the shock when you see when you google it yeah it’s not the greatest experience they wanted a card a card with the questions that mapped against the cue card they wanted this card to take away with them they might have had symptoms in the consultation but if they developed later they wanted to remember what those things were and essentially what to do should they develop if they did speak urgent help they wanted to take this card with them so that it would help them to communicate these sometimes embarrassing but serious symptoms in terms of who should be safety net well we don’t want to safety net every single patient because we’ll end up scaring patients who don’t need to be concerned so you should safety net patients who you think may progress to developing cause recliner syndrome if I’ve gone to the GP and he’s given me a card or a leaflet with a god requirement I could have been probably a any of the weekend rather than wait until the Wednesday so it would have been two maybe three days prior but I could have been in which obviously I know now could have helped with the rehabilitation and the nerve damage that was caused from the recorder coin.if cord recliner syndrome is suspected a careful objective neurological examination should be to evaluate dermatome or sensory loss my term weakness and reflex change sensation of the perineum and digital rectal examination should also be performed by an appropriately trained clinician so if we have to summarize what will be our three take-home messages from today so for me communication would be the important thing it’s important that we frame the important questions we’re asking the patients that we use patient language so they understand exactly what they’re being asked and we’re getting answers to the questions that we’ve asked and that the patient understands exactly what the consequences are of this condition okay and for me it’s about safety netting so it’s like giving the patient a card or some kind of literature so they know exactly what to do if they get some of those symptoms certain for me will be advanced and as a practice in standards of care so I think there are two aspects to that first that aspect will be the documentation so there’s a clear record of the patient’s going through the service and the other thing again going leaking in with the standards of care would be to make sure that people maintain their competencies please listen to your patients listen to what they’re telling you and probably put the puzzle together yeah I think it’s working with patients as partners we can make a real difference to getting these called Aquinas swords to the surgical team in a timely manner you

15 thoughts on “Cauda equina syndrome – a surgical emergency

  1. Thanks for this
    My issue has not been the physiotherapist, but some of the emergency doctors. I have been to my local A&E departments about 3 times over the past few weeks and the last visit the doctor was adamant that I don't have CES, even though I'm I have signs that I have likely CESI. Problem is it seemed that she was looking for/at the acute/complete type. She was determined that I don't have any sensation loss otherwise I would be paralysed. Doesn't she realise that sensation loss depends on which nerves are damaged and how much? I also know people who have no feeling from the waist down and can still walk. She pressed my tummy and said I was sticking it out. I couldn't tell and also maybe it seemed that way because I hadn't been properly opening my bowels. She said I had good tone because she was finding doing a rectal exam difficult and also it was very painful. Overall she suggested that my problems were from reading about things and worry. Yet it was the physiotherapist who had referred me to A&E and done me a letter which stated that I had suspected CES. No MRI was requested because I had recently had one which showed no nerve compression, unless something was missed. When I had my appointment with the physiotherapist, he asked me some questions and ticked a few of the boxes that suggested early red flag symptoms.

    I have just had a neurosurgeon referral go off, but hope it's not too late in terms of damage. I will find out if anything was missed.

    Is it possible that worry can cause some CES symptoms like bladder issues and gradual saddle anaesthesia?

  2. I waited 3 months for a 2nd disc operation for severe sciatica. I’m now completely wheelchair bound and have incontinence of bladder and bowel. I believe that the 3 month wait caused the terrible outcome of CES. It should have been an emergency as I was having continence issues but didn’t know it was even related. I have back and leg spasms everyday. Post physiotherapy that I’ve paid for for over a decade hasn’t helped except training how to deal with spasms and doing daily stretching. I’m now under the care of the QENSIU spinal unit in Glasgow.

  3. I'm 21 and had CES, I spent 2 years with bad back pain and doctors telling me it was all in my head and no one ever believing me because i was "too young to have back issues" November 2017 I was rushed into hospital after my pain had got so bad and i had finally lost all feeling and movement in my legs and my bladder had stopped working. I was then rushed in for emergency surgery December 1st, further needing another 2 emergency operations throughout december! I was in hospital for 2 months because of complications and failed surgeries! I'm now 6 months post 2nd op and have full feeling and movement back in my legs! I was very lucky and was told I was a day away of becoming completely paralyzed. If only the doctors had listened to me 2 years ago I would have not ended up the way I was! I had multiple slipped discs (i still do)i had spinal cord compression and I also have spinal stenosis (which is severe) I still get pains but no numbness, I'm terrified of future issues with my back and completely worried about CES again! Doctors need to listen! just because i'm young doesn't mean I'm not going to get a medical condition!

  4. This video is informative. I had been diagnosed with Cauda Equina Syndrome after my second repeated failed surgeries. This condition had changed my life dramatically. I'm unable to regain my sensory since 2012 until now on my left leg. Nothing can be done as I was told by surgeon. Each day I'm been taking morphine – based painkillers on every 12 hours to suppress the pain else I won't be able to walk on each pain attack. This condition caused me a lots of life changes as it affect my career as well. I can no longer be a productive employee nor running my own home – based sewing as I can't sit for too long.

    I wish there's a specific studies for CES and I'm willing to try on any alternative solutions such as recorrective surgery aside from physiotherapy or painkillers.

  5. This is a great video. If I'd listened too I too would be still working and walking. Not end up in a wheelchair after 2 spinal surgeries followed by sepsis and a spine infection, which led to 2nd surgery further up the spine and another infection, then 3rd surgery to have the hardware removed due to infection was on the hardware so antibiotics couldn't get rid of it. 5 years of my life was in a holding pattern.

  6. Wish my gp had taken me seriously rather than leaving me almost 3 days before I was sent for emergency surgery.

  7. Hello. My name is Azamat. I had an operation 02.07.2013g. I have a good feeling, there is no back pain. I walk on my legs. At this time I am tormented, I cannot urinate on my own, and I still have stool retention. (I remove the feces from the anus with my fingers). I have urinary retention and the feces occurred one day ahead of the operation. The doctors diagnosed: Impairment of the function of the pelvic organs. But I am standing in legs, I do not have back pain. I feel no filling of the bladder, but the urine does not flow out by itself. The cal is not coming out of the rectum. 6 years have passed.At this time I can not urinate while standing, I urinate only in a sitting position. The doctors said that my nerve was disconnected. Is it possible that the nerve connections are present? Help. I look forward to hearing with impatience!

  8. Thank goodness I had microscopic blood in my urine a year ago when I had a cervical fusion because I asked my Dr to check my urine for my checkup just to see and it got worse. I called a urologist and since my kidneys, bladder, and blood work is good she thinks it's the L4-L5 Central protrusion/severe stenosis. My back Dr was just forgetting about my lower back because of the issues with my neck and midback. Thanks to the urologist he apologizes and wants me to call him after my urodynamics test. I had to bring up the urine and bowel weakness and retention and mention my urologist to him twice. I had no clue my urine and weak bowel issues could have anything to do with my centralized disc protrusion. My back Dr didn't bother to ever ask questions. Thanks to me asking for a simple urine test and my urologist asking questions I might be having a laminectomy to release the pressure to save my nerve before it's too late. I already lost some feeling but I can still use my mind to urinate to help the process along. Back dr.'s don't take things too serious because they have seen worse so minor cases (in their eyes) get pushed until it's too late.

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