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BACKGROUND: Cauda equina syndrome (CES) is a lumbosacral surgical emergency that has been associated with chiropractic spinal manipulation (CSM) in case reports. However, identifying if there is a potential causal effect is complicated by the heightened incidence of CES among those with low back pain (LBP). The study hypothesis was that there would be no increase in the risk of CES in adults with LBP following CSM compared to a propensity-matched cohort following physical therapy (PT) evaluation without spinal manipulation over a three-month follow-up period. METHODS: A query of a United States network (TriNetX, Inc.) was conducted, searching health records of more than 107 million patients attending academic health centers, yielding data ranging from 20 years prior to the search date (July 30, 2023). Patients aged 18 or older with LBP were included, excluding those with pre-existing CES, incontinence, or serious pathology that may cause CES. Patients were divided into two cohorts: (1) LBP patients receiving CSM or (2) LBP patients receiving PT evaluation without spinal manipulation. Propensity score matching controlled for confounding variables associated with CES. RESULTS: 67,220 patients per cohort (mean age 51 years) remained after propensity matching. CES incidence was 0.07% (95% confidence intervals [CI]: 0.05-0.09%) in the CSM cohort compared to 0.11% (95% CI: 0.09-0.14%) in the PT evaluation cohort, yielding a risk ratio and 95% CI of 0.60 (0.42-0.86; p = .0052). Both cohorts showed a higher rate of CES during the first two weeks of follow-up. CONCLUSIONS: These findings suggest that CSM is not a risk factor for CES. Considering prior epidemiologic evidence, patients with LBP may have an elevated risk of CES independent of treatment. These findings warrant further corroboration. In the meantime, clinicians should be vigilant to identify LBP patients with CES and promptly refer them for surgical evaluation.

Background: Visceral leishmaniasis (VL) is a neglected tropical disease primarily affecting Brazil, East Africa, and India, with India accounting for 18% of the global burden. While VL typically presents with systemic symptoms like fever, weight loss, and splenomegaly, it can occasionally manifest atypically, posing significant diagnostic challenges. Neurological presentations of VL are extremely rare, making them difficult to suspect and diagnose. Cases where VL predominantly presents with neurological symptoms are particularly novel, underscoring the need for heightened awareness of such atypical manifestations in endemic regions. Clinical case: A 38-year-old man with history of recurrent atypical VL presented with diffuse lower back pain, progressive tingling, numbness, weakness in the lower extremities, and double vision for one month. Clinical and radiological evaluations suggested cauda equina syndrome and cranial nerve palsy, accompanied by generalized lymphadenopathy, subcutaneous nodules, and skin papules. The differential diagnosis initially included disseminated tuberculosis, histoplasmosis, and lymphoma. Cerebrospinal fluid (CSF) analysis revealed an inflammatory syndrome. Histopathology of lymph node and bone marrow revealed Leishmania amastigotes and subcutaneous nodule and skin biopsy revealed inflammatory cells with granulomas. Furthermore, the qPCR test on DNA from a subcutaneous nodule, lymph node, and CSF was positive for Leishmania kinetoplast DNA. The species was further confirmed as Leishmania donovani through ITS-based PCR amplification and sequencing. Finally, a diagnosis of relapse of VL with lymph node, cutaneous, and neurological involvement, including abducens nerve palsy and cauda equina syndrome, was established. He was treated with combination of liposomal amphotericin B and miltefosine, along with intrathecal hyaluronidase, resulting in significant improvement. Conclusion: Unlike previously reported cases with both systemic and neurological symptoms, our patient predominantly presented with neurological manifestations, making this a unique and novel presentation of VL. This case highlights diagnostic challenges and management of atypical VL, emphasizing neurological involvement and successful therapeutic strategies. [ABSTRACT FROM AUTHOR]

The "Proceedings of the 2024 Autumn Meeting of the Society of British Neurological Surgeons" held at Queen Elizabeth Hospital in Birmingham covered a wide range of neurosurgical topics, including seizure prophylaxis, brain metastases surgery, and outcomes for glioblastoma patients. The event emphasized the importance of teamwork in neurosurgery and initiatives to enhance patient care. Additionally, the document includes research from various countries, discussing advancements and challenges in neurosurgery, surgical education, and prescribing practices, showcasing a global perspective in the field. [Extracted from the article]

Purpose: Cauda equina syndrome (CES) may have significant individual consequences if diagnostic delays occur. Our aim was to evaluate the presenting subjective and objective features of patients with suspected CES in comparison to those with radiologically confirmed cauda equina compression (CEC).. Methods: This was a retrospective analysis of all cases presenting with suspected CES to a tertiary emergency care unit over a two-year period. CEC was defined as radiological confirmation of CEC by Consultant Musculoskeletal (MSK) Radiologist report (MSK-CEC) and by measured canal occupancy due to an acute disc extrusion (> 75%)[measured by a Senior Spinal Surgeon (SP-CEC)]. Routine data collection was compared between categories. Chi square, multivariate regression analyses and ROC analysis of multiple predictors was performed. Results: 530 patients were included in this analysis, 60 (11.3%) had MSK-CEC, and 470 had NO- CEC. Only 43/60 (71.7%) had emergent surgery. Those with MSK-CEC and SP-CEC were statistically more likely to present with bilateral leg pain [(MSK-CEC OR 2.6, 95%CI 1.2, 5.8; p = 0.02)(SP-CEC OR 4.7, 95%CI 1.7, 12.8; p = 0.003)]; and absent bilateral ankle reflexes [(MSK-CEC OR 4.3; 95% CI 2.0, 9.6; p < 0.001)(SP CEC OR 2.5; 95%CI 1.0, 6.19; p = 0.05)] on multivariate analysis. The ROC curve analysis acceptable diagnostic utility of having SP-CEC when both are present [Area under the curve 0.72 (95%CI 0.61, 0.83); p < 0.0001]. Conclusion: This study suggests that in those presenting with CES symptoms, the presence of both bilateral leg pain and absent ankle reflexes pose an acceptable diagnostic tool to predict a large acute disc herniation on MRI scan.. Highlights: The most predictive features of radiological cauda equina compression were bilateral leg pain and absent bilateral ankle reflexes when patients present with other features of suspected CES (including any of urinary, bowel, sexual dysfunction and/or perineal sensory change). Radiological definitions of cauda equina compression vary across studies making comparisons difficult across existing evidence. In cases where there is progression of symptoms, in severity, distribution or laterality of symptoms, we would suggest a low threshold for same-day emergency imaging. [ABSTRACT FROM AUTHOR]

Background and objectives: Cauda equina syndrome with retention (CESR) is a severe lumbar condition characterized by painless urine retention due to cauda equina nerve injury. The standard treatment, posterior lumbar interbody fusion (PLIF), often yields suboptimal results. This study aims to compare the clinical safety and efficacy of a novel technique, capsule lumbar interbody fusion (CLIF), with PLIF in CESR patients, hypothesizing that CLIF can enhance neurological recovery by reducing nerve tension. Methods: A single-center, retrospective study was conducted on 83 patients with CESR due to lumbar disc herniation, who underwent either PLIF (n = 44) or CLIF (n = 39). Patients were assessed preoperatively and at 3, 12, and 24 months postoperatively using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF), and Rintala score. Urodynamic studies and nerve tension measurements were also performed. Statistical analysis included t tests, Mann–Whitney U tests, and Spearman's correlation. Results: Both groups showed significant postoperative improvements, but the CLIF group had superior outcomes. At 12 months, the CLIF group had lower VAS scores (1.15 ± 0.84 vs. 1.68 ± 0.60, p = 0.001) and ODI scores (23.31 ± 7.51 vs. 28.30 ± 8.26, p = 0.005). At 24 months, the CLIF group continued to show better results with ODI scores (15.97 ± 6.43 vs. 22.11 ± 6.41, p < 0.001) and higher ODI recovery rates (60.41 ± 17.6% vs. 44.71 ± 18.99%, p < 0.001). The CLIF group also had better ICI-Q-SF scores (2.13 ± 1.23 vs. 3.02 ± 1.45, p = 0.004) and Rintala scores (17.97 ± 1.43 vs. 16.59 ± 1.54, p < 0.001). Lower postoperative nerve tension in the CLIF group correlated with these improved outcomes. Conclusions: CLIF demonstrated superior efficacy over PLIF in treating CESR, with significant improvements in pain relief, functional recovery, and bladder and bowel function. This study highlights the potential of CLIF as a more effective surgical option for CESR, emphasizing its importance in improving patient outcomes and reducing the burden of CESR on patients and society. [ABSTRACT FROM AUTHOR]

The article discusses a case report of a 40-year-old female patient diagnosed with both multiple sclerosis (MS) and ankylosing spondylitis (AS) who was successfully treated with ocrelizumab. AS is a systemic inflammatory disorder primarily affecting the axial skeleton, while MS is a chronic demyelinating disorder of the central nervous system. The patient experienced significant improvement in both AS and MS symptoms with ocrelizumab treatment, achieving inactive disease status with no reported adverse effects. This case highlights the potential benefits of ocrelizumab in treating patients with dual diagnoses of AS and MS, although further research is needed to fully understand its safety and efficacy profile. [Extracted from the article]

INTRODUCTION: The aim of our study was to determine the frequency and severity of low back pain (LBP) after cauda equina syndrome (CES). The study looked at a retrospective, longitudinal cohort of CES medicolegal cases. The historical severity of LBP was compared with the frequency and severity of LBP after CES. METHODS: A consecutive series of 50 patients, assessed between 2015 and 2021, was reviewed. The following information was recorded in all cases: historical and post-CES levels of LBP (visual analogue scale [VAS]), age, sex, level of disc prolapse, motor weakness, bladder dysfunction, depression, fatigue and neuropathic pain. Statistical analysis was performed with paired Student's t-tests. RESULTS: In 32 cases (64%), LBP was worse than prior to CES (same: n=14, 28%; better: n=4, 8%; p<0.001). The mean increase in VAS pain score was 5.2/10. Comorbidities relevant to worse LBP were common: fatigue (n=47, 94%), bladder problems (n=45, 90%), depression (n=39, 78%), motor weakness (n=38, 76%), neuropathic leg pain (n=34, 68%) and pelvic pain (n=16, 32%). CONCLUSIONS: There is increased LBP in two-thirds of patients after CES. This supports the very limited clinical literature. What has not been demonstrated previously is the severity of increased pain (mean 5.2/10) in those who have worse LBP. Increased LBP is probably because factors that exacerbate LBP in any patient are common in patients following CES. [ABSTRACT FROM AUTHOR]

Background: There is no literature specifically addressing the morbidity of out of hours surgery for Cauda Equina Syndrome (CES). Our paper rectifies this omission. This will assist the surgeon with real-time decision making with regards to timing of intervention in this rare but potentially disabling disease. Methods: A retrospective case series analysis. Individual cases were identified using local electronic theatre management systems in the four neurosurgical centres in Scotland in 2017. "Out of hours" surgery was defined as starting outside the times 0900-1700 Monday to Friday. Results: 86 patients underwent out of hours surgery for CES in Scotland in 2017. One patient sustained a nerve root injury without new deficit, giving an overall risk of 1.2%. Four patients had the intra-operative complication of CSF leak, giving an overall risk of 4.7%. Five patients underwent early revision surgery, equivalent to a re-operation risk of 5.8%. Conclusions: The morbidity of out of hours surgery for CES is comparable to that of elective microdiscectomy. Operating out of hours for CES does not appear to have an increased risk of complications. Since increased surgical risk is not borne out by our study, this should not be used as a justification to delay operative treatment. [ABSTRACT FROM AUTHOR]

Cauda equina syndrome is a rare presentation of lumbar spine disease that can result in significant lower limb neurological deficits and permanent bladder, bowel and sexual dysfunction. Delays in diagnosis and treatment can result in irreversible worsening of the condition. Therefore, this is a major cause of litigation against spinal surgeons in the NHS. Urgent MRI scanning is the diagnostic gold-standard and should be available at all hours in all hospitals where patients with potential cauda equina syndrome present. Imaging should be performed within 4 hours of requesting and if the scan is positive for cauda equina compression then treatment should be undertaken as a matter of urgency. Surgery to decompress the cauda equina can prevent further deterioration in symptoms but compared to elective lumbar surgery carries a much higher rate of complications owing to the nature of the disease. Despite rapid treatment, patients can suffer from significant long-term sequelae and require prolonged periods of rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: Interlaminar endoscopic approach has become a main operative option for lumbar disc herniations over the past decade. This method stands out for not only successful pain management but also for low complication rate, as shown in many studies. We aimed to present the results of a single senior surgeon with long-term follow-up. Materials and Methods: The interlaminar approach was executed to 142 patients with lumbar disc herniation. In total, 151 disc herniations were performed. Motor deficit and intractable radicular pain were considered indication for interlaminar endoscopic lumbar discectomy (IELD), similar to open microdiscectomy. Cauda equina syndrome and vertebral instability deemed as contraindications. Results: All patients had severe radicular pain. One hundred and thirty-two patients (92.9%) exhibited positive nerve stretch results, and 67 (47.2%) patients had motor deficit. Ten patients had a history of prior lumbar surgery. L4-L5 (33.1%) and L5-S1 levels (59.2%) were the most frequently operated levels. Nine patients (6.3%) underwent IELD for multiple level. Complications were noted in six patients (4.2%) during hospitalization. Dural tear occured in four patients (2.8%) and motor deficit was observed in one patient (0.7%). No repair surgery was required for dural tear. The mean follow-up duration was 9.1 years. Nine patients (6.3%) had recurrent disc herniation. The mean duration of recurrence was 20.9 months, and 77.8% of recurrences occurred in the first year. One patient underwent posterior stabilization 1 year after the last surgery. No infection or spondylodiscitis was experienced in our cases. Conclusion: The results of a single experienced senior surgeon indicated that IELD was a highly safe method. This method is on course to become a common method for treating many lumbar spine disorders as technological advancements in endoscopic tools and the increase in patient experience. [ABSTRACT FROM AUTHOR]

Simple Summary: The vertebral canal dimensions are crucial for spinal health, as degenerative changes can significantly affect the spinal cord. Compression of spinal nerves at the lumbosacral junction causes cauda equina syndrome (CES), more common in dogs than cats. With regard to the limited information on feline vertebral canal dimensions, this study examined 50 cats, measuring the interpedicular (ID) and midsagittal (SD) diameters as well as the intervertebral disc width (IVDW) in 28 of these animals. The region between the first thoracic (Th1) and the first sacral vertebra (S1) was considered using dissected cats. All cats showed a notable narrowing of the spinal canal from L6 to S1 with the narrowest point at S1. The widest parts of the vertebral canal correspond with the spinal cord enlargements. IVDW was found to be fairly consistent up to Th10–Th11, with the widest discs present at L7–S1 in 95.65% of cats. These data aim to understand potential correlations between the vertebral canal dimensions and the IVDW in terms of predispositions to spinal diseases in cats, especially compressive myelopathies. Further studies should be conducted to investigate the influence of age, sex and breed. As part of the spine, the vertebral canal represents a central structure protecting the spinal cord running within it. Since alterations to the spinal canal and adjacent structures can have a significant impact on the spinal cord, knowledge of the physiological vertebral canal dimensions is essential. Compression of spinal nerves at the lumbosacral junction is the primary cause of cauda equina syndrome (CES). Although CES is common in dogs, it is rarely documented in cats. Given the lack of information on normal vertebral canal dimensions in cats, it is necessary to collect data and verify currently used measurements, to determine if and to what extent comparisons with dogs are valid. In 50 cats, interpedicular (ID) and midsagittal (SD) diameters were examined from the first thoracic (Th1) to the first sacral vertebra (S1). In 28 of these animals, the intervertebral disc width (IVDW) was measured. All data were gathered through gross anatomical dissection of the cats. Significant lumen reduction was evident in all cats from L6 to S1 with the narrowest point at S1. Narrowings were also found in the thoracic spine. The widest points coincide with the spinal cord enlargements. IVDW shows relatively constant values up to Th10–Th11 and peaks at L7–S1 in 95.65% of cats. While distinct similarities to dogs were observed, differences exist. The findings allow conclusions as to whether relations between the parameters and resulting predispositions to pathological changes can be derived. This could help the understanding of the pathogenesis of feline spinal diseases, particularly compressive myelopathies. Further studies are necessary to investigate the impact of age, sex and breed. [ABSTRACT FROM AUTHOR]

Background: Massive central lumbar disc herniations can pose a significant operative challenge. A protruding disc can be approached either through the axilla of the cord or transdurally. Aim of Study: This study aimed to study the outcome of transdural approach in a massive disc prolapse causing cauda equina syndrome. MATERIALS AND METHODS: Of all the cases of disc prolapse, only patients presenting with massive disc protrusion/cauda equina syndrome were selected for the transdural approach. Seven males and three females in the age group of 40–60 years were treated by this method. Results: The transdural approach in a cauda equina patient was remarkably safe, short duration, and satisfactory results. Conclusion: Paraspinal approach through the axilla was superior for disc prolapse were exiting nerve root compression was present. For a fully blown cauda equina syndrome, the trandsural approach was easy, safe, and satisfactory.

Abstract Cauda equina syndrome is a surgical emergency caused by the compression of the lumbosacral nerves. The most frequent cause is discal herniation, while tumoral pathology in this region is rare, and congenital processes are less common. We report the case of a young 37-year-old male patient, admitted to the emergency room with an incomplete cauda equina syndrome. As medical history, a lumbar surgery 15 years ago was reported with no documentation. An MRI was performed, revealing a mass within the filum terminal exhibiting three components suggestive of a dermoid cyst accompanying a split cord malformation, which was confirmed by pathology. Various disorders may be associated to intradural dermoid cyst, such as lipoma, low-lying cord, hydromyelia or thick filum. Surgery is the treatment of choice, and MRI plays a crucial role in detecting associated abnormalities and determining surgery priorities.

Background and Objective: Spinal pathology frequently presents in physiotherapy caseloads, making a thorough understanding of Cauda Equina Syndrome (CES) essential. Although the treatment of CES with physical therapy and rehabilitation is uncommon, this case study aims to identify optimal treatment strategies and early rehabilitation following a traumatic event.Case Presentation: We present a case of a 56-year-old Chinese male who visited Tongji Hospital in 2023 after experiencing a fall. Imaging revealed a burst fracture at the L1 vertebral body, resulting in compression of the corresponding spinal cord. The patient was diagnosed with T12-L1 epiconus syndrome accompanied by L2 CES. Following a comprehensive evaluation, including MRI and motor-sensory function assessments, he underwent a structured rehabilitation protocol and therapeutic management. At the final follow-up, the patient achieved ASIA grade D.Discussion: This case study highlights the effectiveness of comprehensive physical rehabilitation and multidisciplinary collaboration in treating traumatic events that lead to epiconus syndrome with CES. It offers valuable insights for clinical decision-making and highlights the importance of early rehabilitation in enhancing patient outcomes.

Pneumorrhachis (PR) is an uncommon condition characterized by the accumulation of air within the spinal canal. This finding may occur due to various causes, mostly after trauma and medical procedures. It can manifest with various features depending on the underlying cause, the location, and the extent of the air trapped. Clinically, the symptoms in affected patients can span a spectrum, ranging from being asymptomatic to manifesting as radiculopathies resulting from compression. The pneumorrhachis-related cauda equina syndrome is incredibly rare and typically appears as a large volume of air causing compression or irritation of the nerve roots in the lower spinal cord. In this report, we present a female patient whose cauda equina syndrome developed as a result of accidental extradural pneumorrhachis after epidural injection in the lumbar spine.

AbstractBackgroundMethodResultsConclusionThe guidance for clinicians on who requires further investigation when suspecting cauda equina syndrome has become clearer in England following the publication of the national recommendations. This does not have specific advice for those patients who have had recent imaging with no compression, returning to a healthcare provider with a change in symptoms. These cases can cause difficulty for clinicians with limited access to imaging who can often be reassured by previous imaging.This study presents a retrospective review of the case notes of 45 patients presenting on two occasions to the same Emergency Department who underwent magnetic resonance imaging due to the clinical diagnosis of cauda equina syndrome. Those with compression of the cauda equina on the second visit were compared to those without a compressive cause for their symptoms.Patients presenting with an increased number of clinical symptoms associated with cauda equina syndrome on their return visit were more likely to have compression of the cauda equina on imaging.The small numbers in this study would suggest caution, however, if patients present with an increasing number of symptoms further imaging should be considered, even with previous reassuring scans. [ABSTRACT FROM AUTHOR]

Background: Spinal cord lymphomas represent a minority of extranodal lymphomas and often pose diagnostic challenges by imitating primary spinal tumors or inflammatory/infective lesions. This paper presents a unique case of primary cauda equina lymphoma (PCEL) and conducts a comprehensive review to delineate the clinical and radiological characteristics of this rare entity. Case Report: A 74-year-old male presented with progressive paresthesia, motor weakness, and symptoms indicative of cauda equina syndrome. Neurological examination revealed paraparesis and sphincter dysfunction. Imaging studies initially suggested an intradural meningioma. However, surgical intervention revealed a diffuse large B-cell lymphoma infiltrating the cauda equina. Findings: A systematic review of the pertinent literature identified 18 primary cauda equina lymphoma cases. These cases exhibited diverse clinical presentations, treatments, and outcomes. The mean age at diagnosis was 61.25 years for women and 50 years for men, with an average follow-up of 16.2 months. Notably, 35% of patients were alive at 18 months, highlighting the challenging prognosis associated with PCEL. Discussion: Primary spinal cord lymphomas, especially within the cauda equina, remain rare and diagnostically complex due to their nonspecific clinical manifestations. The review highlights the need to consider spinal cord lymphoma in patients with neurological symptoms, even without a history of systemic lymphoma. Diagnostic Approaches: Magnetic resonance imaging (MRI) serves as the primary diagnostic tool but lacks specificity. Histopathological examination remains the gold standard for definitive diagnosis. The review underscores the importance of timely biopsy in suspected cases to facilitate accurate diagnosis and appropriate management. Management and Prognosis: Current management involves biopsy and chemotherapy; however, optimal treatment strategies remain ambiguous due to the rarity of PCEL. Despite aggressive therapeutic interventions, prognosis remains poor, emphasizing the urgency for enhanced diagnostic and treatment modalities. Conclusions: Primary cauda equina lymphoma poses diagnostic and therapeutic challenges, necessitating a high index of suspicion in patients with atypical spinal cord symptoms. Collaborative efforts between neurosurgical, oncological, and infectious diseases teams are imperative for timely diagnosis and management. Advancements in diagnostic precision and therapeutic options are crucial for improving patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Measuring elevated post-void residual volume is important for diagnosing urinary outflow tract obstruction and cauda equina syndrome. Catheter placement is exact but painful, invasive, and may cause infection, whereas an ultrasound is accurate, painless, and safe. Aim: The purpose of this single-center study is to evaluate the accuracy of a module for artificial-intelligence (AI)-based fully automated bladder volume (BV) prospective measurement using two-dimensional ultrasound images, as compared with manual measurement by expert sonographers. Methods: Pairs of transverse and longitudinal bladder images were obtained from patients evaluated in an urgent care clinic. The scans were prospectively analyzed by the automated module using the prolate ellipsoid method. The same examinations were manually measured by a blinded expert sonographer. The two methods were compared using the Pearson correlation, kappa coefficients, and the Bland–Altman method. Results: A total of 111 pairs of transverse and longitudinal views were included. A very strong correlation was found between the manual BV measurements and the AI-based module with r = 0.97 [95% CI: 0.96–0.98]. The specificity and sensitivity for the diagnosis of an elevated post-void residual volume using a threshold ≥200 mL were 1.00 and 0.82, respectively. An almost-perfect agreement between manual and automated methods was obtained (kappa = 0.85). Perfect reproducibility was found for both inter- and intra-observer agreements. Conclusion: This AI-based module provides an accurate automated measurement of the BV based on ultrasound images. This novel method demonstrates a very strong correlation with the gold standard, making it a potentially valuable decision-support tool for non-experts in acute settings. [ABSTRACT FROM AUTHOR]

Cauda equina syndrome is a surgical emergency caused by the compression of the lumbosacral nerves. The most frequent cause is discal herniation, while tumoral pathology in this region is rare, and congenital processes are less common. We report the case of a young 37-year-old male patient, admitted to the emergency room with an incomplete cauda equina syndrome. As medical history, a lumbar surgery 15 years ago was reported with no documentation. An MRI was performed, revealing a mass within the filum terminal exhibiting three components suggestive of a dermoid cyst accompanying a split cord malformation, which was confirmed by pathology. Various disorders may be associated to intradural dermoid cyst, such as lipoma, low-lying cord, hydromyelia or thick filum. Surgery is the treatment of choice, and MRI plays a crucial role in detecting associated abnormalities and determining surgery priorities. [ABSTRACT FROM AUTHOR]

Neurosarcoidosis (NS) with hypothalamic-pituitary (HP) involvement (HP-NS) is a rare clinical condition, conferring variable hormonal deficits that are typically irreversible. Here, we present 2 cases of NS with panhypopituitarism. The first patient presented with cauda equina syndrome and arginine vasopressin deficiency, while the second developed recurrent optic neuritis and vision loss in the setting of a sellar mass. In the first case, neurological symptoms resolved after therapy with high-dose glucocorticoids, infliximab, and methotrexate; while in the second, visual restoration followed resection of the granulomatous tissue and immunosuppressive therapy. In both cases, pituitary dysfunction persisted despite neurological improvement. We contextualized the presentations and outcomes through a literature review of HP-NS case reports and case series. This revealed high rates of extraneurologic sarcoidosis in HP-NS patients with panhypopituitarism, while underscoring the need for hormonal replacement--as endocrinopathies rarely respond to sarcoidosis-directed immunosuppression. [ABSTRACT FROM AUTHOR]

Cauda equina syndrome (CES) can present with a varied constellation of clinical signs and symptoms, which together with the time-sensitive nature of the condition and risk of catastrophic clinical outcome, presents a significant challenge to those assessing patients with this suspected diagnosis. Anal tone is commonly tested during initial assessment using a digital rectal examination (DRE). This study aims to evaluate the diagnostic value of anal tone and perianal sensation assessment in patients with suspected CES and report modern prevalence data on CES within a neurosciences centre. Consecutive patients with suspected CES presenting over three years to the Emergency Department (ED) of a busy tertiary centre were included in the study. History and examination findings, documented in the ED notes, were assessed and these variables were correlated with the presence or absence of cauda equina compression on subsequent magnetic resonance imaging (MRI). Out of 1005 patients with suspected CES, 117 (11.6%) had MRI confirmed cauda equina compression (MRI + ve CES). 35% of MRI + ve patients and 31% of MRI -ve patients had reduced anal tone. Using univariate and multivariable logistic regression analyses, no associations were found between abnormal anal tone and MRI + ve CES for patients of all ages. The univariate logistic regression analysis identified altered perianal sensation to be significantly associated with MRI + ve CES in patients ≤42 years old. This association was no longer present when an adjusted multivariable logistic regression was performed. The prevalence of MRI + ve CES was 11.6%. Our findings suggest that the clinical finding of reduced anal tone has no demonstrable diagnostic value for those with suspected CES, either in itself or in combination with other clinical findings. Further studies are needed to confirm the diagnostic efficacy of assessing perianal sensation in this context. [ABSTRACT FROM AUTHOR]

To report the first case of hyperacute onset of adjacent segmental disease (ASD) with dorsally migrated herniated nucleus pulposus (HNP) causing cauda equina syndrome. A 55-year-old female complained of lower back pain with radiating pain in both lower extremities that had not responded to conservative treatment over the previous six months. Plain radiographs and magnetic resonance imaging (MRI) findings revealed degenerative spondylolisthesis with spinal stenosis at L3–4, L4–5, and a slight bulging disc at L2–3. The patient underwent decompressive total laminectomy and posterior fusion at L3–4 and L4–5. The stenotic symptoms improved significantly after surgery, and she was then discharged on postoperative day 7. However, the patient visited the emergency department four days after discharge (postoperative day 11) complaining of sudden onset of bilateral lower extremity weakness and voiding and defecation difficulties. The follow-up MRI showed dorsally migrated huge HNP and a detached posterior longitudinal ligament (PLL) at L2–3, which was diagnosed as hyperacute onset of ASD causing cauda equina syndrome. The patient underwent an emergency second operation consisting of partial laminectomy at L2–3 with removal of the dorsally migrated huge HNP. After the second operation, the symptoms of cauda equina syndrome improved. One year after the second operation, the patient is doing well without recurrence of symptoms. Our case showed that hyperacute onset of ASD with dorsally migrated huge HNP can cause cauda equina syndrome, even within 2 weeks after lumbar fusion surgery. Therefore, a high index of suspicion, timely diagnosis, and surgical treatment are needed to avoid the catastrophic neurologic complications in similar extremely rare cases. [ABSTRACT FROM AUTHOR]

Diagnosis of low back pain can be intriguing and complex. Careful history-taking and physical examination are essential to ensure red flags (serious issues) are not missed, that treatment is appropriate, evidence-based and timely, and that follow-up and review are well documented and understood by the patient. This article covers some of the more common causes of back pain in primary and urgent care. [ABSTRACT FROM AUTHOR]

Radiculopathy is a commonly encountered symptom in neurosurgical practice. This article discusses the clinical presentation, anatomy, pathophysiology and treatment of radiculopathy, neurogenic claudication and cauda equina syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Cauda Equina Syndrome (CES) is one of the genuine orthopaedic emergencies. Diagnosis of acute CES is challenging and may be missed, resulting in considerable medicolegal claims. In Ireland, nearly €21 million in compensation has been paid out over a 10-year period due to the diagnosis being missed. As a result, defensive practices have resulted in an increased number of referrals for CES to the on-call orthopaedic service in a major trauma unit. Methods: A prospective data-capturing exercise was carried out of all referrals for acute CES to the orthopaedic on-call department in a tertiary-level university-affiliated teaching hospital between August and November 2023. Qualitative data was captured including referral source, referring clinician grade, in-hours or out-of-hours referral, MRI on referral, red flags as identified by the referring team, red flags as identified by the orthopaedic team, and outcome. Results: Forty referrals for CES were made over the duration of this audit. Seventeen (42.5%) referrals were made in-hours, and 23 (57.5%) were referred out-of-hours. Only five (12.5%) of these referrals had an MRI done at the time of the referral. No patients were transferred for an out-of-hours MRI to another hospital. Only five (12.5%) patients required surgical decompression—none of these patients required an out-of-hours emergent decompression. Conclusion: There is a lack of understanding as to what exactly is being referred—resulting in a referral volume which is over ten times the expected number of CES cases being made to our unit. The lack of out-of-hours MRI access poses a significant concern for patient outcomes. [ABSTRACT FROM AUTHOR]

The cauda equina syndrome (CES) is a rare but critical disorder, which can result in devastating motor weakness and sensory deficit, alongside often irreversible bladder, bowel and sexual dysfunction. In addition to the clinical burden of disease, this syndrome results in a disproportionately high medicolegal strain due to missed or delayed diagnoses. Despite being an emergency diagnosis, often necessitating urgent surgical decompression to treat, we believe there is a lack of clarity for clinicians in the current literature, with no published Irish guideline concerning screening or detection. The current study aims to identify and analyse appropriate guidelines in relation to CES screening which are available to clinicians in Ireland. The study design included a comprehensive literature review and comparison of existing guidelines. The review identified 13 sources of appropriate guidance for clinicians working in Ireland. These resources included textbooks, websites and guidelines developed in the UK. No Irish guidelines or advice were available on CES screening/treatment at the time of review. This review demonstrated the lack of consensus and guidance for clinicians in Ireland on how to effectively screen for CES, judge who requires further imaging and investigations and how to rule out the condition. A national consensus on thorough screening and prompt investigation for CES is necessary, and the formulation of new CES guidelines would be a welcome addition to what is available to clinicians currently. [ABSTRACT FROM AUTHOR]

This document contains abstracts from the 10th SICCR National Congress, covering various topics related to colorectal surgery. The abstracts provide brief summaries of studies and presentations on topics such as the use of chlorphenamine as a substitute for opioids in sedating patients during colonoscopy, risk factors for mortality and complications in colorectal cancer surgery, different surgical approaches for rectal cancer, and outcomes of laparoscopic surgery for colon cancer. The studies emphasize the importance of individualized treatment plans and multidisciplinary approaches for optimal outcomes. The document also includes abstracts on other proctological conditions and procedures, such as hemorrhoids and anal fistulas. [Extracted from the article]

Purpose: Mebos, a traditional South Africa confection consisting of dried, pulped, and sugared apricots, is rich in fibre and vitamins, but also contains salicylic acid, flavonoids, and citric acid. We report a case of postoperative surgical site bleeding in a healthy patient who consumed approximately 2 kg of mebos per day prior to his elective spinal surgery. Methods: The clinical course of a previously healthy 54-year-old male patient with cauda equina syndrome secondary to lumbar spinal stenosis who underwent surgical intervention with subsequent bleeding into the surgical site is discussed. The cause was investigated through biochemical analysis, thromboelastometry (ROTEM®) and mass and absorption spectrometry were applied to assess flavonoid, citric acid, and salicylic acid content. Results: ROTEM® revealed an abnormal clotting profile with an increased clot forming time, suggesting intrinsic coagulopathy. Mass and absorption spectrometry revealed a high total flavonoid content as well as citric acid concentration in the mebos. Salicylic acid was at detection limits of the instrument. Conclusion: Results highlighted the effect of flavonoids and citric acid and therefore explain the abnormal clotting profile in this patient. Inhibition of coagulation prior to elective surgery is a known contraindication and may pose great risks in spinal surgery. In the present report, we demonstrated an association between inhibition of coagulation and an excess of the flavonoids content and citric acid concentration in mebos consumed in the days prior to elective spinal surgery. [ABSTRACT FROM AUTHOR]

Purpose: To report a unique case of incomplete CES following a rebar penetrating injury in perineal region with retro-pulsed fragment, which was treated with anterior approach and discuss suitable surgical approach. Methods: Incomplete cauda equina syndrome caused by non-missile penetrating injury is extremely rare. A 26-year-old male patient presented incomplete cauda equina syndrome due to a penetrating rebar wound from his perineal region to the lumbosacral spine. Computed tomography demonstrated a bony fragment broken from S1 body compressing into the spinal canal. Results: By anterior approach, we performed partial corpectomy of L5, decompression by retrieving the bony fragment and L5-S1 interbody fusion. The patient had a significant recovery, and no clinical complication was found after over 2-year follow-up. Conclusion: It is challenging to determine the optimal strategy of surgical treatment for penetrating spinal injuries with retained foreign bodies, here we suggest an anterior approach situation that has the advantage of being able to effectively perform decompression and prevent iatrogenic damages of thecal sac and nerve rootlets. [ABSTRACT FROM AUTHOR]

Background: Factors influencing recovery after decompression surgery for cauda equina syndrome (CES) are not completely identified. The authors aimed to investigate the most valuable predictors (MVPs) of poor postoperative recovery (PPR) in patients with CES and construct a nomogram for discerning those who will experience PPR. Methods: Three hundred fifty-six patients with CES secondary to lumbar degenerative diseases treated at Xijing Hospital were randomly divided into training (N= 238) and validation (N=118) cohorts at a 2:1 ratio. Moreover, 92 patients from the 970th Hospital composed the testing cohort. Least Absolute Shrinkage and Selection Operator regression (LASSO) was used for selecting MVPs. The nomogram was developed by integrating coefficients of MVPs in the logistic regression, and its discrimination, calibration, and clinical utility were validated in all three cohorts. Results: After 3 to 5 years of follow-up, the residual rates of bladder dysfunction, bowel dysfunction, sexual dysfunction, and saddle anesthesia were 41.9, 44.1, 63.7, and 29.0%, respectively. MVPs included stress urinary incontinence, overactive bladder, low stream, difficult defecation, fecal incontinence, and saddle anesthesia in order. The discriminatory ability of the nomogram was up to 0.896, 0.919, and 0.848 in the training, validation, and testing cohorts, respectively. Besides, the nomogram showed good calibration and clinical utility in all cohorts. Furthermore, the optimal cutoff value of the nomogram score for distinguishing those who will experience PPR was 148.02, above which postoperative outcomes tend to be poor. Conclusion: The first pretreatment nomogram for discerning CES patients who will experience PPR was developed and validated, which will aid clinicians in clinical decision-making. [ABSTRACT FROM AUTHOR]

Study Design: This was a systematic review of surgically managed Cauda Equina Syndrome (CES) Outcome Measurement Instruments (OMI). Objective: A core outcome set (COS) defines agreed outcomes which should be reported as a minimum in any research study for a specific condition. This study identified OMIs used in the wider CES literature and compare these to the established CESCOS. Methods: To identify measurement methods and instruments in the CES surgical outcome evidence base, a systematic review was performed. Medline, Embase and CINAHL plus databases were queried. In addition, a secondary search for validation studies of measurement instruments in CES was undertaken. Identified studies from this search were subject to the COSMIN risk of bias assessment. Results: In total, 112 studies were identified investigating surgical outcomes for CES. The majority (80%, n = 90) of these OMI studies were retrospective in nature and only 55% (n = 62) utilised a measurement method or instrument. The remaining 50 studies used study specific definitions for surgical outcomes defined within their methods. Of the 59 measurement instruments identified, 60% (n = 38 instruments) were patient reported outcome measures. Only one validated instrument was identified, which was a patient reported outcome measure. The validated instrument was not used in any study identified in the initial search (to identify measurement instruments). Conclusions: This review highlights the wide heterogeneity of measurement instruments used in surgically managed CES research. Subsequently, there is need for consensus agreement on which instrument or instruments should be used to measure each core outcome for CES surgical outcomes. [ABSTRACT FROM AUTHOR]

Background: Lumbar disc surgery is among the more common spinal procedures. In this paper, we report the current treatment recommendations for patients with symptomatic disc herniation. Methods: This review is based on pertinent publications retrieved by a selective literature search in PubMed using the terms [timing] AND [lumbar disc herniation], supplemented by other relevant articles and guidelines. Results: Symptoms resolve in 60% to 80% of patients with herniated discs in 6--12 weeks, and in 80% to 90% over the long term (≥ 1 year). According to the guidelines, 6--12 weeks of conservative treatment are recommended in the absence of significant neurologic deficits. Early surgery is indicated in case of worsening pain or new onset of neurologic deficits. Lumbar disc herniation associated bladder or bowel dysfunction (cauda equina syndrome) is considered an absolute surgical emergency that requires immediate decompression (within 24 to 48 hours). Patients with severe motor deficits (MRC ≤ 3/5) benefit from early intervention and should be offered surgery within three days, if possible, for the best chance of recovery. The degree of weakness and the duration of symptoms have been identified as risk factors for incomplete recovery. Early surgery can be considered in patients with mild paresis (MRC 4/5) in case of functional impairment (e.g., quadriceps paresis). Conclusion: Longer symptom duration and lower motor scores are associated with worse outcome and a lower chance of neurologic recovery. The recovery rate for motor deficits ranges from 33% to 75%, depending on the timing and modality of treatment as well as the motor score. [ABSTRACT FROM AUTHOR]

Unstable traumas of the spinopelvic junction, which include displaced U-shaped sacral fractures (Roy-Camille type 2 and type 3) and Tile C vertical shear pelvic ring disruptions, occur in severe traumas patients following high speed traffic accident or fall from a height. These unstable traumas of the spinopelvic junction jeopardize one's ability to stand and to walk by disrupting the biomechanical arches of the pelvis, and may also cause cauda equina syndrome. Historically, such patients were treated with bed rest and could suffer a life-long burden of orthopedic and neurological disability. Since Schildhauer pioneer work back in 2003, triangular spinopelvic fixation, whether it is performed in a percutaneous fashion or by open reduction and internal fixation, allows to realign bone fragments of the spinopelvic junction and to resume walking within three weeks. Nevertheless, such procedure remains highly technical and it not encountered very often, even for spine surgeons working in high-volume level 1 trauma centers. Hence, this visual technical note aims to provide a few tips to guide less experience surgeons to complete this procedure safely. [ABSTRACT FROM AUTHOR]

This article presents a case study of a patient who underwent a surgical procedure to treat a thoracolumbar burst fracture with neurological deficit. The surgery involved the use of pedicle screw distraction fixation and expandable jack implant kyphoplasty to restore spinal alignment and decompress the spinal canal. The patient experienced improvements in motor strength and was able to walk without assistance after the surgery. The authors suggest that this surgical technique is an effective and minimally invasive approach to treating lumbar burst fractures with neurological deficits. [Extracted from the article]

Spinal epidural lipomatosis [SEL] is defined as an excessive accumulation of extradural normal adipose tissue. This condition may be idiopathic or acquired. Surgical decompression is considered the gold standard treatment in patients presenting with progressive neurologic deficit. We report a case of a 69-year-old male patient presented with neurogenic claudication and lower left limb radiculopathy. The magnetic resonance imaging (MRI) revealed a L5-S1 epidural compression sustained by a large epidural plaque whose signal was consistent with adipose tissue. A conservative approach, including weight loss attempt, revealed unsuccessful and the patient presented some months after the diagnosis at the emergency department with acute onset bilateral drop foot, more severe on the right side and urinary disturbances. Microsurgical decompression via L5 laminectomy and partial L4 laminectomy and fatty plaque debulking was performed. The post operative course was uneventful and at the two months post operative follow up the patient reported a significative improvement of the pre operative neurological signs and symptoms and of pain control. SEL deserves attention as an identifiable cause of radiculopathies, typically attributed to spinal stenosis, with a higher incidence than previously reported. Moreover cases of acute onset of cauda equina like syndrome were reported in patent affected by SEL, probably related to a local venous engorgement with stasis and edema. Therefore it should be considered as a possible diagnosis not only in patients complaining of stenosis-type symptoms but also in cases of acute neurological decline with cauda equina like syndrome, especially when provided with a "benign" imaging reading. [ABSTRACT FROM AUTHOR]

The first abstract discusses a study on the effects of a mindfulness-based stress reduction program on patients with Parkinson's disease. The program was found to improve psychological distress and quality of life, indicating potential benefits for individuals with Parkinson's disease. The second abstract explores the relationship between sleep disturbances and cognitive function in Parkinson's disease patients, finding that sleep disturbances are associated with poorer cognitive function, particularly in attention and executive function. The third abstract focuses on a study that found a virtual reality-based exercise program to significantly improve balance and gait in individuals with Parkinson's disease. The fourth abstract discusses the positive effects of a dance intervention on motor and non-motor symptoms in Parkinson's disease patients, including improvements in motor symptoms, depression, and anxiety. The fifth abstract examines the effects of a cognitive training program on cognitive function in individuals with Parkinson's disease. [Extracted from the article]

Cauda equina syndrome (CES) is a surgical emergency that often leads to debilitating chronic neuropathic pain, lower limb paralysis, loss of both faecal and urinary continence, and loss of sexual function; all of which cause a large degree of morbidity often causing psychological issues in the patient and a strain on family and their personal relationships. It is usually caused by a space occupying lesion in the lumbrosacral spinal canal causing a compressive mass effect on the peripheral nerve fibres of the cauda equina. This causes a syndrome of lower back pain, sciatica type symptoms, sensory and motor power loss of the lower limbs and perineum including loss of bladder or bowel control. Fortunately, it is relatively uncommon – affecting 1–3 per 100,000 people in England. Suspected CES as a presentation is vastly more common with about 8000 cases a year in England. It is a time-sensitive condition and as such early diagnosis and management of CES is a priority to prevent disability. When CES is diagnosed, it requires an emergency operation to decompress the cauda and prevent long-term disability. [ABSTRACT FROM AUTHOR]

Introduction: Aim of this study is to analyze gender-related epidemiological characteristics of cauda equina syndrome (CES) in Zenica-Doboj Canton in 10 years period. Methods: The study was conducted in the Zenica-Doboj Canton, and data were obtained from the time period between 2012 to 2022. The study included a total sample of 1709 patients diagnosed with disc herniation who underwent surgical decompression. In total, 48 patients developed cauda equine syndrome (CES). Results: The analysis unveiled noteworthy gender disparities, with male predominance (79.2% vs. 20.8%, p

Background: Aside from the rarity of mobile spinal schwannomas, the coexistence of these tumors with herniated intervertebral disc is also scarce. Furthermore, cauda equina syndrome (CES), as a manifestation of intraspinal schwannomas has been reported rarely. Described here is a case of simultaneous lumbar disc bulge and mobile spinal schwannoma presented with intermittent symptoms of CES. Case Report: A 62-year-old man presented with severe but intermittent leg pain for 2 weeks, which later progressed to an episode of lower extremity weakness and difficulty in urination. Magnetic resonance imaging revealed an intraspinal tumor that moved in position relative to the L1-2 disc bulge on scans 6 h apart, with associated spontaneous regression in symptoms. The tumor was found to be a mobile spinal schwannoma, originated from a nerve root. A standard microdissection technique was used to remove the tumor through a spinous processsparing unilateral approach, with complete laminectomy of L1. Use of intraoperative ultrasound facilitated the accurate tumor localization. Postoperatively, the patient no longer had symptoms. Conclusions: This report presents a combination of a common spinal pathology, intervertebral disc herniation, alongside a rare condition, mobile spinal schwannoma, whose uncommon clinical manifestations, such as CES can cause irreversible neurological deficits. Surgeons need to remain vigilant of potential atypical scenarios when treating patients. Surgical treatment challenges regarding the mobility of tumors, such as accurate localization, should be addressed using intraoperative imaging to avoid wrong-level surgery. To mitigate the irreversible neurological complications, patients should receive comprehensive information for alarming signs of CES. [ABSTRACT FROM AUTHOR]

In this case report, we describe an uncommon case of neuroendocrine cancer of unknown origin began with cauda equina syndrome in a patient affected by Paget disease of bone (PDB). A 76-year-old man with diagnosis of PDB, without history of pain or bone deformity, developed sudden severe low back pain. Bone alkaline phosphatase was increased and MRI and whole-body scintigraphy confirmed the localization of the disease at the third vertebra of the lumbar spine. Treatment with Neridronic Acid was started, but after only 2 weeks of therapy anuria and bowel occlusion occurred together with lower limb weakness and walking impairment. Cauda equina syndrome consequent to spinal stenosis at the level of L2–L3 was diagnosed after admission to Emergency Department and the patient underwent neurosurgery for spinal medulla decompression. The histologic results showed a complete subversion of bone structure in neoplastic tissue, consistent with metastatic neuroendocrine carcinoma of unknown origin. In conclusion, low back pain in the elderly may require deep investigation to individuate rare diseases. In asymptomatic patients with apparently stable PDB, the sudden appearance of pain or neurologic symptoms may alert the clinician for the possibility of other superimposing diseases, like bone metastases. [ABSTRACT FROM AUTHOR]

Intravenous (IV) medication administration error remains a major concern during the perioperative period. This review examines inadvertent IV anaesthesia induction agent administration via high‑risk routes. Using Medline and Google Scholar, the author searched published reports of inadvertent administration via neuraxial (intrathecal, epidural), peripheral nerve or plexus or intracerebroventricular (ICV) route. The author applied the Human Factors Analysis and Classification System (HFACS) framework to identify systemic and human factors. Among 14 patients involved, thiopentone was administered via the epidural route in six patients. Four errors involved the routes of ICV (propofol and etomidate one each) or lumbar intrathecal (propofol infusion and etomidate bolus). Intrathecal thiopentone was associated with cauda equina syndrome in one patient. HFACS identified suboptimal handling of external ventricular and lumbar drains and deficiencies in the transition of care. Organisational policy to improve the handling of neuraxial devices, use of technological tools and improvements in identified deficiencies in preconditions before drug preparation and administration may minimise future risks of inadvertent IV induction agent administration. [ABSTRACT FROM AUTHOR]

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This article discusses the diagnosis and treatment of spontaneous acute-onset conus medullaris or cauda equina syndrome caused by spinal acute subdural hematoma. The condition is rare and challenging to diagnose, but prompt diagnosis and emergency surgical decompression are necessary due to the serious nature of the disease. The article presents a case study of a 67-year-old male patient who underwent surgical evacuation of the hematoma and experienced a favorable neurological outcome. The article also discusses the etiology, clinical presentation, and management of spinal acute subdural hematoma, emphasizing the importance of surgical decompression for patients with neurological deficits. [Extracted from the article]

A rare case of aneurysm of the lateral sacral artery is reported. This 46-year-old female presented with complaints of bowel and bladder incontinence and decreased perianal sensation for the past 15 months. She underwent laminectomy and diskectomy for the diagnosis of a prolapsed disk at peripheral hospital where the surgeon was confronted with a severe and unexpected hemorrhage, and surgery was aborted without effective treatment. Prior medical history includes hypertensive kidney disease with a renal transplant eight years ago. Magnetic resonance imaging and angiographic findings were suggestive of a lateral sacral artery aneurysm. Patient with a history of renal transplant and presenting with cauda equina require a more thorough assessment, and a differential of lateral sacral artery aneurysm should always be kept in mind. Our purpose is to report the pre-operative features of the lateral sacral artery aneurysm and its treatment modalities. [ABSTRACT FROM AUTHOR]

Cauda equina syndrome (CES) is a severe neurological condition with potentially high morbidity. Patients usually present with varying degrees of neurological deficit, especially sphincter dysfunction, which needs to be diagnosed early and correctly indicated for surgical treatment. Our retrospective study is focused on the determination of different prognostic factors and their impact on the final neurological outcome of patients with CES. Forty-four CES patients were recruited in the study. The duration of symptoms has proven to be a statistically significant factor in improving the clinical condition. Patients with a shorter medical history of neurological symptomatology had a better neurological outcome. Also, there was a positive relationship between the initial and outcome score, i.e., the outcome status is related to the severity of the neurological deficit on admission. The remaining factors appeared to be statistically insignificant. [ABSTRACT FROM AUTHOR]

Pain can occur after any spinal surgery. Despite this, there are other many signs and symptoms of neurological deficits that can occur in patients with varying severity. Our aim is to find some of the main neurological deficits that can occur after any spinal surgery. We searched the literature based on some of the important keywords like neurological deficits after spine surgery, foot drops, cauda equina syndrome, epidural hematoma, and nerve and dural injury. Based on this we analyzed the most important and widely read articles. The problems associated with spine surgery have been published in the literature but are much more than the failed back surgery syndrome and cause more discomfort to patients with varying degrees of neurological deficits. We have coined a new term "Extended Post-spinal Surgery Syndrome (EPSS)" for these conditions. We propose this to include the other complications after lumbar surgery including nerve injury, dural injury, cauda equina syndrome and epidural haematoma. [ABSTRACT FROM AUTHOR]