Papers

Shades of grey, the challenge of grumbling CES in older adults with lumbar stenosis.

(Comer, Finucane, Mercer, & Greenhalgh, 2019)

Aims: This paper explores the challenges and evidence gaps relating to CES in older adults with LSS.

Methods: Professional issue : author’s point of view.

Results: Lumbar Spinal Stenosis (LSS) can evolve into CES with degenerative changes increasing the compression phenomenon. The symptoms can be “grumbling” and fluctuate according to position and movements. Symptoms can be under-reported as considered “a normal consequence of ageing” Differential diagnosis should be based on careful questioning, consideration of timeframes, and correlation between onset of signs and symptoms that might indicate early or impending CES.

If new or progressing CSE symptoms over few hours or days or weeks refer for urgent MRI.

If gradual progression over months request routing imaging unless other cause explains symptoms if so, provide “safety net” card and advices.

Limitations: author’s opinion.

In Practice: Differential diagnosis should be based on careful questioning, consideration of timeframes, and correlation between onset of signs and symptoms that might indicate early or impending CES. Give card, explain to patients that are at risk of CES the monitoring.

Comer, C., Finucane, L., Mercer, C., & Greenhalgh, S. (2019). SHADES of grey – The challenge of ‘grumbling’ cauda equina symptoms in older adults with lumbar spinal stenosis. Musculoskeletal Science and Practice, (August), 102049. https://doi.org/10.1016/j.msksp.2019.102049

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