The Ambulatory Outcomes of Traumatic Cauda Equina Syndrome and Conus Medullaris Syndrome: a Systematic Review

Objective(s): To determine the ambulatory outcomes described in traumatic CMS (tCMS) and traumatic CES (tCES), and to identify clinical factors affecting the outcomes.

Data Sources: Pubmed, EMBASE, CINAHL, and Cochrane databases were searched from inception to August 2021. Searches were limited to English language, human studies, and adult populations. Abstracts, letters, commentaries, editorials, conference posters, case series, case reports, and pilot studies were excluded. Reporting followed the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines.

Study Selection: Studies were included in this systematic review if they consisted of primary studies (prospective and retrospective cohort studies) of patients with CMS and/or CES, of which trauma was the primary cause of injury; adult aged at least 19 years; the outcomes of the studies involved walking ability or description of lower extremity motor or functional recovery as an outcome.
Studies were excluded if they described nontraumatic causes; or patients with pre-existing conditions that affected walking ability.

Data Extraction: Two independent reviewers screened the studies, extracted relevant information on the ambulatory outcomes of tCMS and tCES, and evaluated the risk of bias of the selected studies using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. If consensus could not be reached, a third reviewer arbitrated.

Data Synthesis: Three of 1152 articles (n=993) were analyzed. Descriptions of ambulatory outcomes were heterogeneous ranging from percentage of patients achieving independent walking, the Lower Extremity Motor Score (LEMS), the instrument Functional Independence Measure (FIM), to the Spinal Cord Independent Measure (SCIM). Fifty-two percent (n=111) of cases with tCES achieved independent walking after rehabilitation, but data on walking ability were lacking for the tCMS cohort. Improvements in lower limb strength and functional mobility were similar in both cohorts.

Conclusions: There is no evidence to suggest that tCMS survivors have a worse prognosis for their motor and mobility improvement compared with tCES. Overall, early rehabilitation, less severe injury, and lower levels of injury are associated with better ambulatory outcomes in these two cohorts.

Author(s) Disclosures: Nothing to disclose