eMedicine Specialties > Neurosurgery > Neoplasm

Cauda Equina: Workup

Author: Nazer H Qureshi, MD, Staff Physician, Department of Neurosurgery, University of Arkansas for Medical Sciences
Coauthor(s): T Glenn Pait, MD, FACS, Associate Professor, Department of Neurosurgery, Department of Orthopaedic Surgery, Jackson T Stephens Chair, Spine Surgery, University of Arkansas for Medical Sciences; Director, Jackson T Stephens Spine and Neurosciences Institute; Emad Soliman, MD, MSc, Consulting Staff, Department of Neurology, St John's Riverside Hospital
Contributor Information and Disclosures

Updated: Jul 24, 2007

Workup

Laboratory Studies

In general, laboratory tests are not required for diagnosing cauda equina syndrome (CES) but may help in prognosticating a particular etiology. For example, a high erythrocyte sedimentation rate (ESR) and C-reactive protein level should prompt consideration of infection as a probable cause of CES.

Imaging Studies

In addition to a complete history, physical examination, neurological evaluation, and baseline laboratory analyses, the diagnostic workup for a cauda equina (CE) disorder is radiological.

Radiography

Plain radiographs should be obtained to search for destructive changes, disc-space narrowing, or loss of spinal alignment.

Lumbar myelography

Myelography is no longer routinely performed because of the availability of MRI. However, they may be preferred in certain situations in which MRI is contraindicated (eg, a patient with a cardiac pacemaker). Obstruction of the flow of contrast dye over an area of compression helps to confirm the level of the suspected pathologic condition.

CT scan with or without contrast

A CT scan is often easier to obtain than a lumbar myelogram. A CT scan provides additional details about bone density and integrity, which is helpful in treatment planning, especially in spine cases in which stabilizing instrumentation is required after the offending agent is relieved from the CE region. CT scanning performed after myelography may demonstrate the blockage of contrast dye and delineate the pathologic condition better than CT scanning alone would.

MRI

MRI is the most helpful modality for the diagnosis of spinal disorders. MRI delineates the soft tissues, including neuronal structures and the offending pathologic condition. It is less helpful than a CT scan in evaluating bone architecture and spinal stability.

Radionuclide scanning

This is a helpful modality when dealing with osteomyelitis and infection of the spine in the setting of CES.

Positron emission tomography scan

Positron emission tomography (PET) in association with CT scanning has been touted as a useful modality in patients with CES and malignancies of the spine.43

Other Tests

Postvoid residual catheterization: Catheterization for residual urine volume may reveal urinary retention, suggesting a neurogenic bladder. More than 100 mL of urine should elicit consideration of CES.

More on Cauda Equina

Overview: Cauda Equina
Workup: Cauda Equina
Treatment: Cauda Equina
Follow-up: Cauda Equina
References
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References

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Further Reading

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Keywords

CE, cauda equina syndrome, CES, low back pain, steroid, epidural, conus medullaris syndrome, spinal stenosis, nerve root, sciatica, lumbar laminectomy, multiple myeloma, metastatic spinal disease, arthritis, degenerative arthritic lumbar stenosis

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Contributor Information and Disclosures

Author

Nazer H Qureshi, MD, Staff Physician, Department of Neurosurgery, University of Arkansas for Medical Sciences
Nazer H Qureshi, MD is a member of the following medical societies: American Association of Neurological Surgeons, Congress of Neurological Surgeons, and World Society for Stereotactic and Functional Neurosurgery
Disclosure: Nothing to disclose.

Coauthor(s)

T Glenn Pait, MD, FACS, Associate Professor, Department of Neurosurgery, Department of Orthopaedic Surgery, Jackson T Stephens Chair, Spine Surgery, University of Arkansas for Medical Sciences; Director, Jackson T Stephens Spine and Neurosciences Institute
T Glenn Pait, MD, FACS is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, Arkansas Medical Society, Congress of Neurological Surgeons, North American Skull Base Society, North American Spine Society, and West Virginia State Medical Association
Disclosure: Nothing to disclose.

Emad Soliman, MD, MSc, Consulting Staff, Department of Neurology, St John's Riverside Hospital
Emad Soliman, MD, MSc is a member of the following medical societies: American Academy of Neurology and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Duc Hoang Duong, MD, Director of Neuroscience Physician Assistant Program, Associate Professor, Departments of Neurological Surgery and Neuroscience, Epilepsy Center, Charles R Drew University
Duc Hoang Duong, MD is a member of the following medical societies: American Neurological Association and North American Skull Base Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ryszard M Pluta, MD, PhD, Associate Professor, Neurosurgical Department Medical Research Center, Polish Academy of Sciences at Warsaw, Poland; Senior Researcher, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH
Disclosure: Nothing to disclose.

CME Editor

Herbert H Engelhard III, MD, PhD, Director, UIC Neuro-Oncology Program, Chief, Division of Neuro-Oncology, Associate Professor, Department of Neurosurgery, University of Illinois at Chicago
Herbert H Engelhard III, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, American Society for Cell Biology, American Society of Clinical Oncology, Chicago Medical Society, Congress of Neurological Surgeons, Illinois State Medical Society, Society for Neuro-Oncology, and Society for Neuroscience
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

 
 
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