World Radiography Day: the role of MRI scans in the diagnosis of Cauda Equina Syndrome

Posted: 08/11/2016

Today is World Radiography Day, and 2016 marks the 121st anniversary of the discovery of x-radiation. The Society of Radiographers uses this day to increase public awareness of diagnostic imaging and radiation therapy.

Yesterday's article highlighted the importance of the use of imaging in the diagnosis of orthopaedic fractures. Here we focus on the crucial role that MRI scans play in the diagnosis of a rare, and little-known condition amongst the general public called Cauda Equina Syndrome.

What is Cauda Equina Syndrome?

Cauda Equina Syndrome (CES) is a very serious condition which involves extreme pressure and swelling of the nerves at the end of the spinal cord. It is a medical emergency that calls for urgent surgical intervention. The symptoms can develop suddenly and can get worse if left undiagnosed and untreated within a relatively short period of time.  The onset of the condition is often described using the following distinctions:

• Acute onset – this is marked by a rapid development of symptoms that can include severe low back pain, significant loss of bladder and bowel function, and numbness in the peri-anal area. The onset, sensory and motor deficits in the lower body typically develop within 24 hours.
• Gradual onset – the condition can develop progressively and symptoms may come and go over the course of several weeks or months. Gradual onset usually typically involves partial or intermittent loss of bowel and bladder function, as well as recurring low back pain in combination with muscle weakness and numbness. Sciatica may also occur in one or both legs.

It is possible for patients to develop Cauda Equina Syndrome with no history of back pain. Others may have a long or recent history of low back pain or sciatica.

If the compression is not identified quickly and resolved through surgery to remove the pressure, permanent damage can be caused leading to altered lower body sensation, problems with mobility, and bladder, bowel and sexual dysfunction. The impact of these disabilities is often life-changing. Because of the speed with which Cauda Equina Syndrome can develop and the short window of opportunity to treat it effectively, swift action is critical. However, since it is relatively rare and often preceded by ‘routine’ back pain, it is often missed by healthcare professionals which can lead to devastating consequences.

If doctors are concerned about the prospect of Cauda Equina Syndrome, then urgent investigation will be required with an MRI scan.

What is an MRI?

By definition, an MRI scan (Magnetic Resonance Imaging) is a method of producing extremely detailed pictures of body tissues and organs without the need for X-rays. The electromagnetic energy that is released when exposing a patient to radio waves in a strong magnetic field is measured and analysed by a computer, which forms two or three dimensional images that may be reviewed on a TV monitor. Over the last ten years, the volume of MRI scans performed in the UK has increased by some 211%, which reflects both the increasing availability of this form of investigation and the aim for earlier diagnosis of medical conditions.

While most hospitals will have MRI scanning facilities, unfortunately access can be limited at certain times - for example at weekends and bank holidays, and during late evenings. This can prove particularly problematic when doctors are presented with a patient with such a time sensitive condition as Cauda Equina Syndrome.

Naomi Holland, an associate in the clinical negligence team at Penningtons Manches, comments: "Radiography plays such a vital role in the diagnosis and treatment of patients with an array of conditions, and it is important that hospitals have ready access to these facilities at any time and on any day of the week. Unfortunately, we have acted on a number of cases where suspicion of Cauda Equina Syndrome has been raised by a clinician, but due to limited access to MRI scans, patients have experienced significant delays in obtaining a formal diagnosis and in undergoing surgery. Where hospitals have limited access to scanning facilities, it is vital that health professionals are pro-active in referring patients to nearby or specialist hospitals.”

For more information on World Radiography Day, visit the Society of Radiographers website.

If you, a member of your family or a friend have concerns about the management of Cauda Equina Syndrome, or any other spine-related problems, our specialist team may be able to assist.

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