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This retrospective audit evaluated compliance with British Association of Spine Surgeons (BASS) and Getting It Right First Time (GIRFT) guidance for streamlined referral pathways and timely MRI use for suspected CES at a UK tertiary centre. Among 353 urgent and emergency referrals over 15 weeks, 102 were suspected CES and only 6 were confirmed, with MRI pre-referral in 48% (94% within 24 hours) and lower compliance out of hours.",{"@graph":69,"@context":126},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/cauda-equina-syndromemost-frequent-referral-diagnosis-to-a-tertiary-spinal-centre-a-retrospective-study/450897/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/cauda-equina-syndromemost-frequent-referral-diagnosis-to-a-tertiary-spinal-centre-a-retrospective-study/450897.png","ImageObject",300,407,{"name":92,"@type":93},"นรินทร์","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118,122],{"name":109,"@type":110,"acceptedAnswer":111},"How was compliance with CES referral guidelines evaluated in this study?","Question",{"text":112,"@type":113},"Electronic urgent and emergency referral records were retrospectively reviewed to assess whether patients received MRI scans before referral and within 24 hours of symptom presentation.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What proportion of suspected CES referrals were confirmed and required surgery?",{"text":117,"@type":113},"Out of 353 urgent and emergency referrals, 102 (29%) were suspected CES, but only 6 cases (1.7% overall; 5.9% of suspected cases) were confirmed and required surgical intervention.",{"name":119,"@type":110,"acceptedAnswer":120},"How did MRI access and guideline adherence differ between daytime and out-of-hours referrals?",{"text":121,"@type":113},"MRI was completed before referral in 48% of suspected CES cases, and compliance differed significantly between daytime (72%) and out-of-hours referrals (31%).",{"name":123,"@type":110,"acceptedAnswer":124},"What changes do the authors recommend based on the findings?",{"text":125,"@type":113},"The study highlights the need to improve 24/7 MRI access, strengthen compliance with national CES pathways, and adjust workforce and resources to optimise imaging access and reduce inappropriate referrals.","https://schema.org",{"og:url":83,"og:type":128,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":130,"canonical":83},"index,follow",{"doc_id":132,"site_id":62},450897,1790793240,{"code":4,"msg":5,"data":135},{"doc_id":132,"user_id":136,"nickname":92,"user_avatar":137,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":143,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":144,"faqs":145,"seo_title":146,"seo_description":67,"update_tm":147,"read_time":148,"preview_page_count":4},2336475104957,"https://ap-avatar.wpscdn.com/avatar/22000c4c6bd8a5076e1?x-image-process=image/resize,m_fixed,w_180,h_180&k=1787554080175789136","Cauda equina syndrome—most frequent referral diagnosis to a tertiary spinal centre: a retrospective study  \nEteesha Rao1^, Shashank Chitgopkar2  \n1Newcastle University Medical School, Newcastle University, Newcastle-Upon-Tyne, UK; 2Department of Spinal Surgery, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK  \nContributions: (I) Conception and design: S Chitgopkar; (II) Administrative support: None; (III) Provision of study materials or patients: SChitgopkar; (IV) Collection and assembly of data: E Rao; (V) Data analysis and interpretation: E Rao; (VI) Manuscript writing: Both authors; (VII) Final approval of manuscript: Both authors.  \nCorrespondence to: Eteesha Rao, MBBS, MRes. Newcastle University Medical School, Newcastle University, Framlington Place, Newcastle-upon  \nTyne NE2 4HH, UK. Email: [eteesha.rao1@nhs.net](eteesha.rao1@nhs.net).  \nBackground: Cauda equina syndrome (CES) is a rare but critical surgical emergency, with a global incidence of 1–3 cases per 100,000 annually. Despite its rarity, CES has paradoxically emerged as one of the most common referral diagnoses to tertiary spinal centres. This discrepancy between referral rates and the actual prevalence of CES raises concerns about potential over-referral and inefficiencies in clinical pathways.  \nThis study aimed to evaluate compliance with national guidelines from the British Association of Spine Surgeons (BASS) and Getting It Right First Time (GIRFT) concerning the streamlined referral pathways and timely magnetic resonance imaging (MRI) utilisation for suspected CES at a major tertiary spinal centre  \nin the UK.  \nMethods: A retrospective audit was conducted on all urgent and emergency CES referrals (n=353) received by a tertiary spinal centre via an electronic referral system over a 15-week period (June–September 2023) .  \nElectronic patient records were retrospectively reviewed to assess compliance with national CES pathway standards, particularly the proportion of patients receiving MRI scans prior to referral and within 24 hours  \nof symptom presentation. Data analysis was performed using IBM SPSS.  \nResults: Of the 353 urgent and emergency referrals, 102 (29%) were for suspected CES, but only 6 cases (1.7%) were confirmed and required surgical intervention. MRI scans were completed before referral in 48% of suspected CES cases, with 94% being within 24 hours of presenting with symptoms. Compliance rates  \nsignificantly differed between daytime (72%) and out-of-hours referrals (31%) .  \nConclusions: Despite clear national guidelines, adherence to recommended CES pathways remains suboptimal, particularly regarding timely MRI access and pre-referral imaging. Variations in guideline compliance, especially out-of-hours, highlight the need for improved access and workforce adjustments to  \noptimise resource utilisation, reduce inappropriate referrals, and prioritise care for true CES patients.  \nKeywords: Cauda equina syndrome (CES); magnetic resonance imaging (MRI); referrals; spine surgery  \nSubmitted Jul 01, 2025. Accepted for publication Sep 15, 2025. Published online Dec 19, 2025.  \ndoi: 10.21037/jss-25-112  \nView this article at: [https://dx.doi.org/10.21037/jss-25-112](https://dx.doi.org/10.21037/jss-25-112)  \n^ ORCID: 0009-0003-6219-7769.  \n© AME Publishing Company. J Spine Surg 2025;11(4):906-912 | [https://dx.doi.org/10.21037/jss-25-112](https://dx.doi.org/10.21037/jss-25-112)  \nJournal of Spine Surgery, Vol 11, No 4 December 2025 907  \nIntroduction  \nCauda equina syndrome (CES) is a rare but critical surgical emergency, occurring due to compression of the spinal cord and its associated nerves arising from L1 to L5 spinal levels (1) . CES has a prevalence of 1 in 30,000– 100,000 people per year and an estimated incidence of 1.5–3.4 per million people per year (2,3) . In 45% of patients with CES, the most common cause is lumbar intervertebral disc herniation. Other causes include epidural abscess, spinal epidural ","cbCaidzamdId87ES","https://ap.wps.com/l/cbCaidzamdId87ES","pdf",557538,"English","# Introduction\n# Methods\n# Results\n# Conclusions\n# Highlight box\n## Key findings\n## What is known and what is new?\n## What is the implication, and what should change now?","[{\"question\":\"How was compliance with CES referral guidelines evaluated in this study?\",\"answer\":\"Electronic urgent and emergency referral records were retrospectively reviewed to assess whether patients received MRI scans before referral and within 24 hours of symptom presentation.\"},{\"question\":\"What proportion of suspected CES referrals were confirmed and required surgery?\",\"answer\":\"Out of 353 urgent and emergency referrals, 102 (29%) were suspected CES, but only 6 cases (1.7% overall; 5.9% of suspected cases) were confirmed and required surgical intervention.\"},{\"question\":\"How did MRI access and guideline adherence differ between daytime and out-of-hours referrals?\",\"answer\":\"MRI was completed before referral in 48% of suspected CES cases, and compliance differed significantly between daytime (72%) and out-of-hours referrals (31%).\"},{\"question\":\"What changes do the authors recommend based on the findings?\",\"answer\":\"The study highlights the need to improve 24/7 MRI access, strengthen compliance with national CES pathways, and adjust workforce and resources to optimise imaging access and reduce inappropriate referrals.\"}]","Cauda equina syndrome—most frequent referral diagnosis to a tertiary spinal centre: a retrospective study | PDF",1790734057,18]