Potential referral pathway for suspected Cauda Equina Syndrome (CES)

Title : Potential referral pathway for suspected Cauda Equina Syndrome (CES)

Abstract:

Background: Cauda Equina Syndrome (CES) is a rare but time-critical spinal emergency requiring rapid diagnosis and intervention to prevent irreversible neurological deficits. Delays in imaging and referral remain a significant challenge in many healthcare systems.

Aim: To present and evaluate a structured referral pathway for suspected CES, designed to streamline patient triage, expedite MRI access, and ensure timely orthopaedic involvement.

Methods: This pathway targets patients presenting with symptoms of less than two weeks’ duration, or those with progressive neurological deficits including motor weakness, bladder, bowel, or sexual dysfunction. Patients meeting criteria are directed to the Emergency Department (ED), where a standardized flowchart determines eligibility for urgent MRI. Imaging requests are clearly labelled “CES” to prioritise radiological assessment. Patients are transferred to the Emergency Assessment Unit (EAU) while awaiting MRI and subsequently referred to orthopaedics. Out-of-hours protocols ensure direct orthopaedic admission if CES is suspected.
Radiology services provide emergency MRI within defined hours, with escalation to on-call services outside these times. A standardized MRI protocol includes sagittal and axial sequences of the entire spine with appropriate overlap between regions to avoid missed pathology.

Results: Implementation of this pathway is expected to reduce delays in diagnosis, improve coordination between ED, radiology, and orthopaedics, and enhance patient safety through early identification of CES.

Conclusion: A clearly defined, multidisciplinary referral pathway is essential for the effective management of suspected CES. Standardisation of imaging protocols and escalation processes ensures timely diagnosis and intervention, ultimately improving neurological outcomes and reducing medico-legal risk.

Biography:

Amr Mohamed Foad Mohamed is a Trauma & Orthopaedics Registrar at Watford General Hospital with a strong academic and clinical background. He completed Core Surgical Training with a focus on T&O in the East Midlands Deanery and has demonstrated proficiency in managing acute trauma cases and performing complex procedures, including neck of femur and ankle fracture surgeries. He holds a PGCert in Medical Education from Cardiff University and is actively involved in undergraduate and postgraduate teaching with Imperial College London and the University of Leicester. Dr Basha is the first author of a systematic review on buprenorphine for postoperative pain and a co-author in multiple orthopaedic publications. His audit and quality improvement projects have been presented nationally and internationally. He has a long-term interest in hip and knee arthroplasty, robotic surgery, and medical education, aiming to contribute to global orthopaedic outreach work in the future.