Is there an electrical signature of cauda equina syndrome (CES) on neurophysiological monitoring?

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From the Research

Neurophysiological Monitoring of Cauda Equina Syndrome

• The use of neurophysiological monitoring in cauda equina syndrome (CES) has been explored in various studies 1, 2, 3.
• Intraoperative neurophysiologic monitoring (IOM) techniques, such as somatosensory evoked potentials (SEPs), transcranial motor-evoked potentials (MEPs), and the bulbocavernosus reflex (BCR), can be used to assess the functional integrity of neural structures during surgery 1.
• Electrophysiological findings, including BCR and electromyography (EMG), can provide insight into the neurophysiological effects of electrical stimulation on patients with CES 2.
• A clinical classification scheme of CES based on factors including clinical symptoms, imaging signs, and electrophysiological findings can be useful for proper treatment 3.

Electrical Stimulation and Cauda Equina Syndrome

• Spinal cord stimulation (SCS) has been reported to improve motor and urinary symptoms in patients with CES 4, 5.
• Electrical stimulation (ES) can improve neurogenic bowel dysfunction (NBD) in patients with CES, and electrodiagnostic testing can offer insight into the neurophysiological effects of ES 2.
• The use of ES and SCS in the treatment of CES requires further investigation to understand the mechanism of action and optimize therapy 4, 5, 2.

Diagnostic Criteria and Treatment Outcomes

• Bilateral radiculopathy or sciatica are early stages of CES and indicate a high risk of development of advanced CES 3.
• Electrophysiological abnormalities and reduced saddle sensation are indices of early diagnosis, and patients at the preclinical and early stages have better functional recovery than patients in later stages after surgical decompression 3.
• The outcome of treatment, including radiographic and electrophysiological findings, can be compared between different groups of patients with CES to evaluate the effectiveness of treatment 3.