Indian Spinal Injuries Center, Vasant Kunj, New Delhi, 110070, India.
Eur Spine J. 2020 Jun;29(6):1236-1247. doi: 10.1007/s00586-019-06277-7. Epub 2020 Jan 6.
The present consensus suggests urgent surgical decompression if clinical features of cauda equina syndrome (CES) are supported by MRI evidence of pressure on cauda equina. However, clinical diagnosis has a high false-positive rate and MRI is a poor indicator. Though urodynamic studies (UDS) provide objective information about the lower urinary tract symptoms experienced by patients including neurogenic bladder, its role in the diagnosis of CES is not established.
To evaluate the ability of an objective urological assessment protocol using uroflowmetry + USG-PVR as screening test and invasive UDS as confirmatory test in patients with suspected CES to rule out neurological impairment of the bladder function.
A retrospective study was conducted on all patients who were referred to our institution with equivocal findings of cauda equina syndrome from January 2014 to December 2018 with positive MRI findings. An algorithm using multichannel UDS was followed in all the included patients.
Out of 249 patients who fulfilled the inclusion criteria, 34 patients (13.65%) had normal uroflowmetry and USG-PVR findings; 211 patients underwent the invasive UDS. Only 141(57.6%) patients out of 245 patients had neurovesical involvement due to compression of cauda equina; 67 patients were treated conservatively using the objective protocol. Only one patient treated conservatively had to undergo emergency decompression for deterioration in symptoms.
Multichannel UDS provides an objective diagnostic tool to definitively establish the neurovesical involvement in CES. Utilising multichannel UDS as an adjunct to clinical findings avoids the probability of false-positive diagnosis of CES. These slides can be retrieved under Electronic Supplementary Material.
目前的共识认为，如果 MRI 证据显示马尾受压，且临床有马尾综合征 (CES) 的特征，应紧急进行减压手术。然而，临床诊断的假阳性率很高，MRI 也不是很好的指标。虽然尿动力学研究 (UDS) 提供了有关患者下尿路症状的客观信息，包括神经性膀胱，但它在 CES 诊断中的作用尚未确定。
评估使用尿流率+USG-PVR 作为筛查试验和侵入性 UDS 作为确认试验的客观泌尿科评估方案在疑似 CES 患者中的作用，以排除膀胱功能的神经损伤。
对 2014 年 1 月至 2018 年 12 月因 MRI 阳性而转诊至我院且 CES 表现不明确的所有患者进行回顾性研究。所有纳入患者均遵循多通道 UDS 算法。
在符合纳入标准的 249 例患者中，34 例（13.65%）尿流率和 USG-PVR 检查正常；211 例患者进行了侵入性 UDS。245 例患者中有 141 例（57.6%）因马尾受压导致神经源性膀胱；67 例患者根据客观方案接受保守治疗。仅 1 例接受保守治疗的患者因症状恶化而不得不进行紧急减压。
多通道 UDS 提供了一种客观的诊断工具，可明确确定 CES 中的神经源性膀胱受累。将多通道 UDS 作为临床发现的辅助手段，可以避免 CES 假阳性诊断的可能性。这些幻灯片可以在电子补充材料中检索。
