Early recognition of Cauda Equina Syndrome: A Framework

UCO Deputy Vice-Chancellor (Research), Steven Vogel has recently been involved in the development of a national framework for the assessment and referral of early Cauda Equina Syndrome (CES).

CES is a rare condition which affects spinal nerves supplying function to the bladder, bowel, and genitalia. When compression of these nerves is confirmed, identification of this condition and subsequent urgent action is required to achieve the best possible outcome.

CES is a challenging condition to diagnose as it may present as an emergency at any time(1). Therefore, it is imperative that clinicians are able make a diagnosis quickly and manage the patient effectively, as undue delay in diagnosis may have devastating and life changing consequences for patients and also result in high cost negligence claims.

Previous attempts have been made to provide clear unified guidance to guide clinicians through their decision-making in assessing patients with possible CES. Despite this, patients continue to suffer from the complications of delayed and missed diagnoses.

As a direct result of this, the National Back Pain Clinical Network (NBP-CN) has launched new guidance; The Framework of Assessment and Referral of Early CES for Primary Care clinicians and MSK interface services. The purpose of this framework is to address the many challenges faced by clinicians in recognising and managing the condition in primary care and offers an evidence-based approach to the management of these patients.

The framework is aligned to the British Association of Spine Surgeons /Society of British Neurological Surgeons Standards of Care for Investigation & Management of CES and will help support primary care clinicians to assess and identify patients with emerging CES and aid them to act appropriately.

The Framework was successfully launched at two well-attended webinars on 15th and 16th of July 2020 and recordings of the webinars and the subsequent question and answer sessions are now available to view.  

Dairmaid Ferguson, Chair of the National Back Pain Pathway – Clinical Network said:

“The Framework is the result of collaborative working between numerous professional bodies and other stakeholders. For the first time, it brings together a consensus in this important area of practice and provides opportunities to really make a positive difference to patients”

The framework is now available online and is open for comments and suggestions until Friday 14 August 2020. Feedback will then be reviewed by an expert panem and the framework will be finalised in Autumn 2020.