No turning back: a long-term retrospective analysis of urgent magnetic resonance imaging (MRI) performed for suspected cauda equina compression in a tertiary referral centre.

AIM

Cauda equina syndrome is a rare but potentially serious condition for which diagnosis is time-critical for the best outcomes. Magnetic resonance imaging (MRI) is the imaging modality of choice, but the diagnostic pathway is challenging as availability of 24/7 urgent MRI is mostly limited to tertiary centres. We present a 13-year experience at one such tertiary centre.

MATERIALS AND METHODS

All lumbar spine MRIs performed for suspected cauda equina between 2011 and 2023 were identified retrospectively from trust-wide information technology (IT) systems. Data including time from request to scan acquisition and reporting times were analysed using automated methods with manual validation.

RESULTS

At our institution, there has been a 10-fold increase in demand for MRI to exclude cauda equina compression over the last decade. In recent years, the mean duration from request to MRI acquisition was within the 4-hour national target in approximately 90% of cases, and time from MRI acquisition to first verified report met the 1-hour national target in just over half of cases (51.1% in 2023). In 2023, 90.0% of reports were verified within 4 hours and 77.5 % within 2 hours, satisfying locally defined standards. Since 2012, 377 patients with clinical suspicion of cauda equina syndrome and positive MRI proceeded to spinal surgery within a week. The mean 5.1% operative rate between 2012 and 2023 corresponds well to previous literature.

CONCLUSION

There is a rising demand for urgent MRI to exclude cauda equina compression with consequent logistical and financial considerations required to meet new national guidance on scan acquisition and reporting targets.