Papers

Assessment and management of CES

(Greenhalgh, Finucane, Mercer, & Selfe, 2018)

Aim: The purpose of this paper is to highlight the many challenges faced by clinicians in recognising and managing CES and offer guidance on the evidence-based management of these patients.

Methods: Masterclass

Results: The early symptoms of CES are often subtle and vague.

1. Bilateral neurogenic sciatica – Pain associated with the back and/ or unilateral/bilateral leg symptoms may be present.

2. Reduced perineal sensation – Sensation loss in the perineum and saddle region

3. Altered bladder function leading to painless urinary retention – Bladder dysfunction can range from increased urinary frequency, difficulty in micturition, change in urine stream, urinary incontinence and urinary retention.

4. Loss of anal tone – loss or reduced anal tone – Bowel dysfunction may include faecal incontinence, inability to control bowel motions and/or in- ability to feel when the bowel is full with consequent overflow.

5. Loss of sexual function

Importance of chronology and evolution. Improving of pain does not necessarily mean the condition is improving. Many cofounders: Medication, PMH, Spinal surgery history. Full neuro needed. Documenting what is done with time. If suspicion backup with CES card.

Limitations: Author’s review of literature.

In practice: Importance of questioning, objective exam, masqueraders, documenting.

Greenhalgh, S., Finucane, L., Mercer, C., & Selfe, J. (2018). Assessment and management of cauda equina syndrome. Musculoskeletal Science and Practice, 37(June), 69–74. https://doi.org/10.1016/j.msksp.2018.06.002

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