Bell D A, Collie D, Statham P F
Department of Neurosurgery, St George's Hospital, London, UK.
Br J Neurosurg. 2007 Apr;21(2):201-3. doi: 10.1080/02688690701317144.
The indications for magnetic resonance imaging (MRI) in suspected cauda equina syndrome, and the urgency for this investigation are regularly disputed. In this study we assess the ability of neurosurgical residents to predict on clinical grounds in which patients with cauda equina syndrome (CES) this was due to prolapsed intervertebral disc thereby justifying a request for urgent MR imaging.
Prospective cohort study of all adult patients with a suspected diagnosis of cauda equina syndrome.
A single tertiary referral neurosurgical centre.
All patients referred over a four month period with a suspected diagnosis of cauda equina syndrome.
MRI was normal in 10 (43%) patients. A disc prolapse causing cauda equina distortion was present in 5 (22%) patients. The diagnostic accuracy of urinary retention, urinary frequency, urinary incontinence, altered urinary sensation and altered perineal sensation were 0.57, 0.65, 0.61 ,0.65 and 0.60 respectively.
Because it is impossible in a significant proportion of patients to exclude the diagnosis of prolapsed intervertebral disc in the context of referral with suspected cauda equina compromise the authors recommend urgent MRI assessment in all patients who present with new onset urinary symptoms in the context of lumbar back pain or sciatica.
疑似马尾综合征患者进行磁共振成像（MRI）检查的指征以及该检查的紧迫性一直存在争议。在本研究中，我们评估神经外科住院医师基于临床依据预测哪些马尾综合征（CES）患者是由椎间盘突出所致的能力，从而判断是否有必要进行紧急MRI检查。
对所有疑似马尾综合征的成年患者进行前瞻性队列研究。
一家单一的三级转诊神经外科中心。
在四个月期间转诊的所有疑似马尾综合征患者。
10例（43%）患者的MRI检查结果正常。5例（22%）患者存在导致马尾神经受压的椎间盘突出。尿潴留、尿频尿急、尿失禁、尿感觉改变和会阴感觉改变的诊断准确性分别为0.57、0.65、0.61、0.65和0.60。
由于在相当一部分疑似马尾神经受压的转诊患者中，无法排除椎间盘突出的诊断，作者建议对所有在腰背痛或坐骨神经痛背景下出现新发泌尿系统症状的患者进行紧急MRI评估。
