Abstract
Fraser S, Roberts L, Murphy E. Cauda equina syndrome: a literature review of its definition
and clinical presentation.
Objective
To review the current evidence for the signs and symptoms of cauda equina syndrome
(CES).
Data Sources
Relevant literature sourced through Medline, Embase, and CINAHL using the key search
words “cauda equina syndrome” combined with “definition,” “clinical presentation,”
“signs and symptoms,” “pathology,” and “etiology.”
Study Selection
Not applicable.
Data Extraction
Not applicable.
Data Synthesis
Three reviewers independently extracted data on CES from the literature specific to
its definition, clinical presentation, and etiology. Of 111 articles, 105 were included
for review, and relevant information on CES was synthesized into a framework structured
as per a clinical consultation. A content analysis was then conducted using the method
adopted by the Chartered Society of Physiotherapy whereby the level of consensus for
each sign and symptom of CES was determined by its percentage coverage within the
literature: 100% coverage equals unanimity, 75% to 99% equals consensus, 51% to 74%
equals majority view, and 0% to 50% equals no consensus. This enabled the frequency
of each reported sign and symptom to be ranked. Articles that included specific definitions
for CES were divided into 3 categories: those that (1) included generalized statements,
(2) stated a pathomechanical basis, and (3) defined the syndrome by its clinical presentation.
Throughout this review, the frequencies of specific etiologies and pathologies were
noted. Together with details of clinical presentation, this enabled a comprehensive
review of CES. No single aspect of CES within the literature achieved unanimity or
consensus; however, a majority view indicated that there would be bladder and sensory
disturbance (74% and 66% of all articles, respectively). The most commonly cited pathology
resulting in CES was identified as the disk (45% of all articles reviewed).
Conclusions
There are marked inconsistencies in the current evidence base surrounding the etiology
and clinical presentation of CES, with 17 definitions identified. Subclassifications
of the definition of CES are ambiguous and should be avoided. From reviewing 105 articles,
a single definition of CES is proposed. For a diagnosis of CES, one or more of the
following must be present: (1) bladder and/or bowel dysfunction, (2) reduced sensation
in the saddle area, and (3) sexual dysfunction, with possible neurologic deficit in
the lower limb (motor/sensory loss, reflex change).
Key Words
List of Abbreviations:
CES (cauda equina syndrome)To read this article in full you will need to make a payment
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Article info
Footnotes
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated. Roberts discloses that her University post is funded by the Arthritis Research Campaign.
Reprints are not available from the author
Identification
Copyright
© 2009 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
