Delay in Diagnosis & Treatment of Cauda Equina Syndrome (CES, Spinal Cord Compression)

Evaluate breaches in the standard of care for Delay in Diagnosis & Treatment of Cauda Equina Syndrome (CES, Spinal Cord Compression)

Answer the following questions to find out if the standard of care was followed for your case.

  • Did the patient present with spinal trauma?
    Yes
    No
    Why is this important?
    The patient with spinal trauma must be assessed, resuscitated and treated upon arrival to the healthcare facility according to Advanced Trauma Life Support principles.
    (2012) 30 ESURGO 3 122-128

  • Was the patient’s spine properly immobilized? Why is this important?
    Answer this question
    Proper spine immobilization requires the use of a cervical collar, backboard, and lateral support device to ensure complete immobilization of the spine. “
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  • Was the patient referred to a specialist? Why is this important?
    Answer this question
    Regardless of the etiology, immediate referral to a neurosurgeon or orthopedic surgeon is required for treatment of cauda equina syndrome. If magnetic resonance imaging confirms cauda equina syndrome, immediate surgical referral is justified.
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  • Was an informed consent obtained? Why is this important?
    Answer this question
    The laws of most states require that (surgeons, physicians, dentist, or clinicians) obtain informed consent before providing treatment.
    (2011) 23 EOMSCA 3 475-484

  • Was deep vein thrombosis prophylaxis administered? Why is this important?
    Answer this question
    Prophylaxis for venous thromboembolism must begin no later than 72 hours after the onset of a spinal cord injury.
    (2007) 88 APMERE 3S1 S55-S61

  • Were prophylactic antibiotics administered? Why is this important?
    Answer this question
    Prophylactic antibiotics may be necessary to decrease the rate of infections after spinal surgery.
    (2009) 9 ESPNJL 2 142-146

  • Which of the following treatment procedures were performed? (Choose all that apply) Why is this important?
    Answer this question
    Corticosteroids (e.g., methylprednisolone) are usually reserved for patients with traumatic cauda equina syndrome.
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  • Was a supra-pubic or Foley catheter inserted? Why is this important?
    Answer this question
    Acute urinary retention resulting from lesion at the conus and cauda equine may require catheterization.
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  • Was padding of the patient’s bony prominences provided? Why is this important?
    Answer this question
    Spinal cord injury patients are at an increased risk for pressure sore development in the immediate post-injury time period.
    (2007) 44 ECURPS 2 101-143

  • Which of the following rehabilitation measures were initiated? (Choose all that apply) Why is this important?
    Answer this question
    Patients with cauda equina syndrome, regardless of the underlying etiology, are left with long-term motor, sensory, genitourinary and bowel control deficits. A multidisciplinary approach including physical therapy and occupational therapy may play a role in improving the patient's functional outcome after surgical decompression and to teach the patient correct lifting and load-bearing techniques may be beneficial in preventing recurrence of cauda equina syndrome.
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  • Was patient education provided? Why is this important?
    Answer this question
    Factors that predispose patients to cauda equina syndrome will need to be addressed. The patient needs to understand the limitations imposed by the sequale they have developed from their condition.
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  • Were follow-up evaluations advised? Why is this important?
    Answer this question
    A follow-up visit in the outpatient clinic must take place seven to ten days after surgery. A follow-up magnetic resonance imaging must be performed.
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  • With which of the following symptoms did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    The main features of cauda equina syndrome include acute low back pain with radiation of pain to the legs, an alteration of perineal sensation, and an alteration of bladder and/or bowel habits-urinary retention and/or constipation.
    (2004) 18 ECORTH 1 58-62

  • Was a medical history obtained? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.
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  • Was a physical examination performed? Why is this important?
    Answer this question
    A careful documentation of the physical examination performed, including time course of symptoms, and a detailed neurological examination is vital. Compression of multiple lumbar and sacral nerve roots causes impairment of bladder, bowel and/or sexual function and peri-anal numbness. These hallmark symptoms may also be accompanied by motor weakness in the lower limbs.
    (2012) 30 ESURGO 3 122-128

  • Which of the following laboratory investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    Laboratory investigations are necessary to assess the overall status of the patient.
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  • Which of the following imaging studies were performed? Why is this important?
    Answer this question
    Cauda equina syndrome is confirmed by magnetic resonance imaging (MRI) of the lumbar and sacral spine.
    (2012) 30 ESURGO 3 122-128

  • Which of the following was identified as the etiology of the cauda equina syndrome? Why is this important?
    Answer this question
    The majority of cases of cauda equina have diskal etiology, with disc herniation into the spinal canal causing compression of the thecal sac and nerve roots.
    (2012) 30 ESURGO 3 122-128

  • Was the patient referred to a specialist? Why is this important?
    Answer this question
    Regardless of the etiology, immediate referral to a neurosurgeon or orthopedic surgeon is required for treatment of cauda equina syndrome. Patients with back pain resulting from a co-morbidity will need care administered by those specific medical specialties.
    Click here for additional information at Clinicalkey.com