Reader response: “Scan-negative” cauda equina syndrome: A prospective cohort study
AymericAmelot, neurosurgeon and specialist of medullar cord lesion, Département de Neurochirurgie, Hôpital de Bretonneau, Tours, France and INSERM U1253, faculté de Tours, France, Tours
AlexiaPlanty-Bonjour, Neurosurgeon, Département de Neurochirurgie, Hôpital de Bretonneau, Tours, France and INSERM U1253, faculté de Tours, France, Tours
Louis-MarieTerrier, Neurosurgeon and neurophysiologist, Département de Neurochirurgie, Hôpital de Bretonneau, Tours, France and INSERM U1253, faculté de Tours, France, Tours
Submitted December 17, 2020
We read with great interest the article by Hoeritzauer, et al.1 This work could develop into both a reference and a warning concerning the difficulty in approaching a CES diagnosis. The preeminent result was that only 24% of their patients had a “scan positive” CES.
In fact, to suggest a potential alternative explanation for “scan-negative CES”, we believe that it would be interesting to determine the proportion of patients who were followed by a spine specialist (81% of the patients in their series suffered from pain, or low-back pain). Indeed, a CES prognosis is dramatic, with highly disabling long-term dysfunction sequelae,2 and is feared by all specialists. Furthermore, it develops in a vast majority of cases from pre-existing vertebral disc disease.3
Although emergency interventions are in favor of improved outcomes, the only true effectiveness on outcome lies within the education and prevention of patients concerning the clinical signs that should be tracked down and consulted for: the slightest appearance of deficit, genito-sphincter disorders, or hyperalgesia.
We believe that for patients who are psychiatrically vulnerable (> 80% in the “scan-negative CES” group of Hoeritzauer et al.), living in a climate of anxiety and hyper-awareness of the threat that CES represents, may promote somatization and other mental health manifestations. In this group it would not be surprising to identify patients presenting several "scan-negative CES" alerts.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Hoeritzauer I, Carson A, Statham P, et al. “Scan-negative” cauda equina syndrome: A prospective cohort study. Neurology Epub 2020 Nov 11.
Korse NS, Veldman AB, Peul WC, Vleggeert-Lankamp CLA. The long term outcome of micturition, defecation and sexual function after spinal surgery for cauda equina syndrome. PloS One 2017;12:e0175987.
Korse NS, Jacobs WCH, Elzevier HW, Vleggeert-Lankamp CLA. Complaints of micturition, defecation and sexual function in cauda equina syndrome due to lumbar disk herniation: a systematic review. Eur Spine J 2013;22:1019–1029.
We read with great interest the article by Hoeritzauer, et al.1 This work could develop into both a reference and a warning concerning the difficulty in approaching a CES diagnosis. The preeminent result was that only 24% of their patients had a “scan positive” CES.
In fact, to suggest a potential alternative explanation for “scan-negative CES”, we believe that it would be interesting to determine the proportion of patients who were followed by a spine specialist (81% of the patients in their series suffered from pain, or low-back pain). Indeed, a CES prognosis is dramatic, with highly disabling long-term dysfunction sequelae,2 and is feared by all specialists. Furthermore, it develops in a vast majority of cases from pre-existing vertebral disc disease.3
Although emergency interventions are in favor of improved outcomes, the only true effectiveness on outcome lies within the education and prevention of patients concerning the clinical signs that should be tracked down and consulted for: the slightest appearance of deficit, genito-sphincter disorders, or hyperalgesia.
We believe that for patients who are psychiatrically vulnerable (> 80% in the “scan-negative CES” group of Hoeritzauer et al.), living in a climate of anxiety and hyper-awareness of the threat that CES represents, may promote somatization and other mental health manifestations. In this group it would not be surprising to identify patients presenting several "scan-negative CES" alerts.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References