A systematic review of the presentation of scan-negative suspected cauda equina syndrome |
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| Affiliation: | 1. Royal College of Surgeons in Ireland, St. Stephen''s Green, Dublin, Ireland;2. School of Medicine, Trinity College Dublin, Dublin, Ireland;3. St. James''s Hospital, Dublin, Ireland;4. Department of Orthopaedic Surgery, Our Lady''s Children''s Hospital, Crumlin, Dublin, Ireland;5. Spine Service, Department of Trauma & Orthopaedic Surgery, Tallaght University Hospital, Dublin, Ireland;6. National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland;1. Peter MacCallum Cancer Centre, Department of Surgical Oncology, Australia;2. Peter MacCallum Cancer Centre, Department of Medical Oncology, Australia;3. Sir Peter MacCallum Dept. of Oncology, University of Melbourne, Australia;1. Health Education England North West, Otolaryngology Department, Tameside General Hospital, Fountain Street, Ashton-Under-Lyne, OL6 9RW, UK;2. Health Education England North West, Plastic Surgery Department, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT, UK;3. Health Education England North West, Stepping Hill Hospital, Poplar Grove, Hazel Grove, SK2 7JE, UK;1. Department of Trauma and Orthopaedics, Foothills Medical Centre, 1403 29 St NW, Calgary, AB T2N 2T9, Canada;2. Department of Trauma and Orthopaedics, Royal Manchester Children''s Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom;3. Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road London, NW1 2BU, United Kingdom;1. NHS Tayside, Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, United Kingdom;2. Institute of Motional Analysis and Research, Tayside Orthopaedics and Rehabilitation Technology Centre, United Kingdom;3. Columbia Asia Hospital, Thaltej, Ahmedabad, Gujarat 380059, India;1. NHS Lothian, Department of ENT/Head and Neck Surgery, UK;2. NHS Lothian, Department of Pathology, UK;3. NHS Lothian, Department of Endocrinology, UK |
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| Abstract: | BackgroundA significant proportion of patients presenting with suspected cauda equina syndrome (CES) do not have associated radiological evidence to support the diagnosis, often termed ‘scan-negative’. Due to the limited number of studies regarding the matter, there is no clear understanding for this presentation. As a result, no treatment protocol exists for the scan-negative group. The purpose of this review is to assess the potential contributing factors leading to the presentation of suspected CES with normal imaging.MethodsA systematic review was conducted on PubMed and Cochrane databases. Bibliographies of key articles and Google Scholar were searched for additional results. The search strategy provided 204 results. Of those, 8 had no identifiable causation for suspected CES and were included for systematic review.Results6 of 8 studies investigated for a difference in clinical presentation between cohorts that may indicate a normal scan. Studies were either inconclusive and contradictory. Two studies suggest a functional somatic disorder as reasoning for negative MRI, with positive provisional findings.ConclusionA psychogenic hypothesis is plausible and warrants further investigation. The need for additional studies is essential to scheming a potential treatment protocol for the scan-negative population, which currently does not exist. |
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| Keywords: | Cauda equina syndrome Negative MRI Spine Medical emergency Neurology Spinal surgery |
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