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£1.2M award to improve diagnosis of emergency spinal condition

04/08/2022

The National Institute for Health and Care Research has awarded an Advanced Fellowship to Oxford University Hospitals (OUH) Emergency Medicine doctor David Metcalfe to study the diagnosis of the spinal condition cauda equina syndrome.

Cauda equina syndrome is caused when the nerves at the end of the spinal cord, collectively called the cauda equina, are compressed.

These nerves supply the legs, bladder, anus and sexual organs, and can be permanently damaged if compressed for too long. 
Most patients with cauda equina syndrome require an emergency operation to take pressure off the nerves. 

Severe back pain can be a sign of cauda equina syndrome, and patients often present to Emergency Departments with pain, but very few actually have the condition. There is, as yet, no particular pattern of symptoms that can rule out the diagnosis without an MRI scan, but with no MRI scanning available at night some patients end up waiting too long before getting a diagnosis.

Dr Metcalfe, a University of Oxford Clinical Lecturer in Emergency Medicine whose work is supported by the NIHR Oxford Biomedical Research Centre (BRC), said: "Cauda equina syndrome is a spinal emergency and this project will help design services to achieve the best possible outcomes for this group of patients."

Claire Thornber, Founder of the Cauda Equina Syndrome Association said: "We are reassured by these efforts to address the issues around Cauda Equina Syndrome diagnosis, management and rehabilitation, as so many patients are being lost in a system without pathways.

"The Cauda Equina Syndrome Association are looking forward to helping this project ensure all patients can access the services they need when and where they need them."

The Cauda Equina Syndrome Early Recognition (CESER) study, which has been awarded £1.23m by the NIHR, has four phases.

  • Analysis of data from previous studies to identify symptoms that predict which patients have the condition.
  • Recruitment of 2,000 patients with suspected cauda equina syndrome, who will be examined by a doctor and then undergo an MRI scan. This will determine which symptoms help identify patients with a final diagnosis of the condition.
  • All NHS hospitals will be asked how they manage patients who might have cauda equina syndrome to identify differences and find examples of best practice.
  • The study will involve a range of stakeholders who will review the evidence and help develop recommendations about the assessment and diagnosis of patients with suspected cauda equina syndrome. 

These studies will help provide high-quality care across the NHS for patients that might have cauda equina syndrome with a view to making healthcare more efficient (and so possibly cheaper) as well as reducing harm to patients.

Pictured: Dr David Metcalfe