Lumbar microdiscectomy for cauda equina syndrome surgical technique
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Lumbar disc prolapse is a common condition. Cauda equina syndrome is a rare complication of disc prolapse and occurs in around 1.8 per million people. It may present with back pain and/or sciatic pain, bladder or bowel dysfunction, perineal or saddle anaesthesia, and unilateral or bilateral lower limb radiculopathy. It can affect patients of any age but is more common in patients with disc degeneration
It can be divided into CES with retention (CES-R) where there is painless urinary retention, or CES incomplete (CES-I) where there is alteration of normal bladder and bowel function. Both conditions should be investigated and treated as an emergency to prevent long-term sequelae and disability with persistent bladder and bowel dysfunction. It is a different condition to those uncommon elderly patients who have critical spinal stenosis and may have intermittent perineal numbness which comes on at the same time as lower limb claudication symptoms and resolves with sitting.
There has been debate over the years of the critical time to surgery, with this varying from 6 hrs up to 48hrs. The British Association of Spine Surgeons (BASS) and the Society of British Neurological Surgeons (SBNS) published recommendations in Dec 2018 which suggest operating at the earliest safe opportunity. This depends on local expertise, the available resources, and the duration of symptoms.
This feature discusses the features of cauda equina syndrome and how to manage this. It is an important aspect of spinal pathology to be familiar with if you are involved with any aspect of emergency care, spinal or orthopaedic patients.
Author: Mr Stephen Morris FRCS (Tr & Orth)
Institution: The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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