Background and purpose: Overlooking a potential diagnosis of cauda equina syndrome (CES) can result in severe long-term neurologic deficits. There is a growing trend to order urgent magnetic resonance imaging (MRI) scans of the lumbar spine in any patient presenting with signs suspicious for CES. A substantial number of these MRI scans do not show cauda compression. The purpose of this study is to assess whether clinical characteristics can predict MRI-confirmed cauda compression.
Methods: We retrospectively studied 58 consecutive cases of suspected CES who presented at our hospital's emergency room.
Results: Eight of 58 patients had cauda compression on MRI. When measured, MRI + CES patients (6) had more than 500 ml urinary retention. Moreover, when these patients had at least two of the following characteristics: bilateral sciatica, subjective urinary retention or rectal incontinence symptoms, MRI was more probable to demonstrate cauda compression with an OR of 48.00, 95% (CI 3.30-697.21), which was also significant (P of 0.04). The presence of other symptoms or signs alone was not significantly different between both groups.
Conclusion: In our series, urinary retention of more than 500 ml alone or in combination with two or more specific clinical characteristics were the most important predictors of MRI confirmed cauda compressions.