The failure of subcategorization of cauda equina syndrome.

The diagnostic sub-categorization of cauda equina syndrome (CES) is used to aid communication between doctors and other healthcare professionals. It is also used to determine the need for, and urgency of, MRI and surgery in these patients. A recent paper by Hoeritzauer et al (2023) in this journal examined the interobserver reliability of the widely accepted subcategories in 100 patients with cauda equina syndrome.

Medico-legal implications of dementia following concussion in rugby football.

There is litigation in respect of dementia in ex-rugby football players. The allegation is that these ex-players have suffered a traumatic encephalopathy syndrome causing dementia and other neurological problems. The syndrome is alleged to have been caused by repeated concussion during play.

Demonstrating the expertise of an expert witness in the civil court: Use of a concise CV after the judgment in .

The suitability of an unregistered expert psychologist to give evidence to the Family Court was considered in [2023] EWHC 345 (Fam). An important part of the judgment focused on the need for an expert witness to demonstrate, in a short, concise and relevant CV, why they have the expertise to give opinion evidence in the case. The judgment has important implications for experts in civil litigation, where the same issues arise.

The British Athletics Muscle Injury Classification grading system as a predictor of return to play following hamstrings injury in professional football players.

Objectives: Investigate the British Athletics Muscle Injury Classification (BAMIC) grading system as a predictor of return to play (RTP) following primary hamstring strain injury (HSI) and its agreement with the Peetron's classification system in professional footballers.

Methods: A retrospective cohort study of 39 hamstrings strains in a professional English football club were identified. Two musculoskeletal radiologists reviewed historical MRI's and classified them against the BAMIC and Peetron's grading system.

Post-void bladder ultrasound in suspected cauda equina syndrome-data from medicolegal cases and relevance to magnetic resonance imaging scanning.

Objective: Post-void residual (PVR) scans of less than 200 ml are increasingly being used to rule out the likelihood of cauda equina syndrome (CES) and to delay emergency MRI scanning in suspected cases. This study was done to review a series of 50 MRI confirmed cases of CES and to test the hypothesis that a PVR of less than 200 ml was unlikely to be present.

Methods: Fifty consecutive medicolegal cases involving CES were audited.

Cauda equina syndrome-a practical guide to definition and classification.

Purpose: International uniformity of definition and classification are crucial for diagnosis and management of cauda equina syndrome (CES). They are also useful for clinicians when discussing CES with patients and relatives, and for medicolegal purposes.

Methods: We reviewed published literature using PubMed on definition and classification of cauda equina syndrome since 2000 (21 years).

Spinal reperfusion syndrome. A literature review and medicolegal implications.

To consider the diagnosis of spinal reperfusion syndrome (SRS) and its medicolegal implications.. .

Informed consent in spinal surgery.

Informed consent is a very important part of surgical treatment. In this paper, we report a number of legal judgements in spinal surgery where there was no criticism of the surgical procedure itself. The fault that was identified was a failure to inform the patient of alternatives to, and material risks of, surgery, or overemphasizing the benefits of surgery.

The surgical treatment of non-specific low back pain.

The National Institute for Health and Care Excellence has issued guidelines that state fusion for non-specific low back pain should only be performed as part of a randomised controlled trial, and that lumbar disc replacement should not be performed. Thus, spinal fusion and disc replacement will no longer be routine forms of treatment for patients with low back pain. This annotation considers the evidence upon which these guidelines are based.

Guidelines for cauda equina syndrome. Red flags and white flags. Systematic review and implications for triage.

Introduction: Patients with cauda equina syndrome (CES) are frequently referred late when neurological damage cannot be reversed. National Guidelines for emergency referral, imaging and treatment of CES contain symptoms and/or signs that are those of late often, irreversible CES. Referral at this stage may be too late for that patient.

Cauda equina syndrome: is the current management of patients presenting to district general hospitals fit for purpose? A personal view based on a review of the literature and a medicolegal experience.

There is no universally agreed definition of cauda equina syndrome (CES). Clinical signs of CES including direct rectal examination (DRE) do not reliably correlate with cauda equina (CE) compression on MRI. Clinical assessment only becomes reliable if there are symptoms/signs of late, often irreversible, CES.

Neurological deterioration in cauda equina syndrome is probably progressive and continuous. Implications for clinical management.

Fifty-six human and animal studies of cauda equina syndrome (CES) were reviewed. The evidence from human studies was poor (level IV). Evidence from animal studies and limited evidence from human studies suggest that structural and functional neurological losses are a progressive, continuous process.