Definition
- A patient presenting with acute back pain and or leg pain with a suggestion of disturbance of their bladder or bowel function and or saddle sensory disturbance should be suspected to have CES
One or more
- Bladder and or bowel dysfunction
- Reduced sensation in saddle area
- Sexual dysfunction with possible neurological deficit in lower limb
Spectrum
- CESS (Suspected) unilateral to bilateral symptom
- CESI (Incomplete) spinster disturbance
- CESR (Retention) retention is painless
- 26% progress from CESI to CESR over 24 hours (1% every hour)
Symptoms suggesting MRI
- B/L sciatica
- B/L parashesia
- B/L motor
- Perineal pain
- Perineal parasthesia
- Altered bowel and or bladder
- Bladder dysfunction
Talk
- I will ask the patient to void urine, Do an Ultrasound scan to see the residual volume, if >250ml
- catheterise the patient
- Tug test
- Positive, MRI
- (Post void bladder scan in ACES trial )
DRE
Digital rectal examination
- will not predict MR positive CES unless and until the CE is severe and irreversible (Gooding et al, BJ NS, 2013)
- More reliable is perineal parasthesia
MRI
- Triage
- Done at local hospital
- 14-33% positive
- 4-7% undergo decompression
Decompression
- Operate with in 48 hours
- Operate as soon as possible