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Assessment of Cauda Equina Syndrome Progression Pattern to Improve Diagnosis

Sun, Jing-Chuan PhD*; Xu, Tao PhD*; Chen, Ke-Fu PhD*; Qian, Wei MMed; Liu, Kun PhD*; Shi, Jian-Gang PhD*; Yuan, Wen MD*; Jia, Lian-Shun MD*

doi: 10.1097/BRS.0000000000000079
Diagnostics

Study Design. Meta-analysis of individual patient data.

Objective. To date, the progression pattern of cauda equina syndrome (CES) has not been summarized. This study assessed individual patient data from CES cases, investigated the CES progression pattern to help clinicians provide timely diagnoses.

Summary of Background Data. Because there were few randomized controlled trials about CES, our research was based on case reports of CES with detailed medical history.

Methods. We searched English literature regarding CES in the PubMed database. We included a total of 198 publications involving 264 cases that met the inclusion criteria. The occurrence order of symptoms was determined by reviewing patients' medical histories, and the progression pattern of CES was analyzed using sequential pattern mining. Finally, we summarized and reassessed the current timing of CES diagnosis.

Results. Result of sequential pattern mining demonstrated that the progression process of CES could be divided into 3 stages: early stage of CES (CESE), with bilateral peripheral nerve dysfunction characterized by progressive sensory-motor defects from unilateral to bilateral in lower extremities; incomplete CES, with reduction of sphincter functions; and CES in retention, with sphincter dysfunction. Among all the cases, 81.08% (180 cases) were diagnosed at the stage of incomplete CES or CES in retention, in which 99.4% (179 cases) had experienced CESE without being diagnosed.

Conclusion. The characteristic progressive sensory-motor CESE defects in lower extremities marked CES onset. Instead of waiting for the onset of sphincter function abnormalities, CES should be diagnosed when the CESE symptoms manifest.

Level of Evidence: 3

The progression pattern of cauda equina syndrome (CES) has not been summarized, which lead to delayed diagnosis. In our study, we found that the progression process of CES could be divided into 3 stages. Instead of waiting for the onset of sphincter function abnormalities, CES should be diagnosed when the progressive sensory-motor symptoms manifest.

*Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, P. R. China; and

Center for Clinical Epidemiology and Evidence-Based Medicine, Second Military Medical University, Shanghai, China.

Address correspondence and reprint requests to Jian-Gang Shi, PhD, Orthopedics Department, Changzheng Hospital, Shanghai, China, 200003; E-mail: shijiangangspine@163.com

Acknowledgment date: June 3, 2013. First revision date: August 27, 2013. Acceptance date: October 2, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

The National Natural Science Foundation of China (Grant No. 3087261, 81271351) funds were received to support this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins