Publication:

Early spinal decompression after documentation in the initial CES-S and CES-R stages of Cauda Equina syndrome: saving both the patient and the clinician

Background Cauda equina syndrome (CES), described by Mixter Barr in 1934, is a rare and acute surgical emergency, and in our observation, the slower stages of bowel, bladder or limb dysfunction are more common than that claimed in the literature. This paper is to remind clinicians to document all the clinical changes of an evolving CES because patients could already be slipping into a progressive CES but will not reveal them unless inquired.

Methods The IRT Programme for Medicos and Doctors (IRTP) of KRUSHI Orthopaedic Welfare Society, an NGO based in India, emphasises "preventive orthopedics", conducted this compilation study which is a mixed or ambispective study design of 650 patient data of which 450 patient data was from direct study in our KOWS research purview and 150 patients from various data bases like the Scopus, Web of Science, PubMed, JSTOR, and ScienceDirect.

Results Incidence of early stages of CES may be missed if only bladder dysfunction is given importance while taking in the patient information by the clinician as only of 33% of the patients complain of bladder dysfunction whereas genital numbness is 47%, sexual dysfunction is of 53% of incidence when carefully enquired into.

Conclusions The slower forms of cauda equina syndrome are usually missed by the clinicians if they trivialise the red flags of the autonomic dysfunction which are more frequent than that noticed and also the radiologist is equally responsible for not reporting enough about the redundant nerves (RND), the spinal canal diameters as smaller canals promote CES even with a smaller compression. If the clinician asks the right questions, the patients in these slower CES (S), CES(R) will never be missed. This article highlights the sigmoid curve pathophysiology and highlights the time frame and emphasis the early stages of CES(S) and CES (R) to be the best stages where the surgery is beneficial.