Article

OBJECTIVE: To review the current evidence for the signs and symptoms of cauda
equina syndrome (CES). DATA SOURCES: Relevant literature sourced through Medline,
Embase, and CINAHL using the key search words "cauda equina syndrome" combined
with "definition," "clinical presentation," "signs and symptoms," "pathology,"
and "etiology." STUDY SELECTION: Not applicable.
DATA EXTRACTION: Not applicable.
DATA SYNTHESIS: Three reviewers independently extracted data on CES from the
literature specific to its definition, clinical presentation, and etiology. Of
111 articles, 105 were included for review, and relevant information on CES was
synthesized into a framework structured as per a clinical consultation. A content
analysis was then conducted using the method adopted by the Chartered Society of
Physiotherapy whereby the level of consensus for each sign and symptom of CES was
determined by its percentage coverage within the literature: 100% coverage equals
unanimity, 75% to 99% equals consensus, 51% to 74% equals majority view, and 0%
to 50% equals no consensus. This enabled the frequency of each reported sign and
symptom to be ranked. Articles that included specific definitions for CES were
divided into 3 categories: those that (1) included generalized statements, (2)
stated a pathomechanical basis, and (3) defined the syndrome by its clinical
presentation. Throughout this review, the frequencies of specific etiologies and
pathologies were noted. Together with details of clinical presentation, this
enabled a comprehensive review of CES. No single aspect of CES within the
literature achieved unanimity or consensus; however, a majority view indicated
that there would be bladder and sensory disturbance (74% and 66% of all articles,
respectively). The most commonly cited pathology resulting in CES was identified
as the disk (45% of all articles reviewed). CONCLUSIONS: There are marked
inconsistencies in the current evidence base surrounding the etiology and
clinical presentation of CES, with 17 definitions identified. Subclassifications
of the definition of CES are ambiguous and should be avoided. From reviewing 105
articles, a single definition of CES is proposed. For a diagnosis of CES, one or
more of the following must be present: (1) bladder and/or bowel dysfunction, (2)
reduced sensation in the saddle area, and (3) sexual dysfunction, with possible
neurologic deficit in the lower limb (motor/sensory loss, reflex change).

Langue : ANGLAIS