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Suitability of Spinal CT For Imaging Cauda Equina Syndrome During The Covid-19 Pandemic
EP34414
Poster Title: Suitability of Spinal CT For Imaging Cauda Equina Syndrome During The Covid-19 Pandemic
Submitted on 30 Oct 2020
Author(s): Jestine Ang and Debasis Das
Affiliations: Radiology Department, Lister Hospital
This poster was presented at British Institute of Radiology
Poster Views: 866
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Poster Information
Abstract: Many NHS hospitals do not provide 24-hour on-site MRI provision for the investigation of cauda equina syndrome (CES), a potentially life-changing condition warranting urgent surgical intervention. In lieu of this, designated regional spinal surgical units provide out-of-hours access for spinal MRI following emergency transfer of patients to their sites. During the Covid 19 pandemic, however, this referral system broke down in our region in order to minimise unnecessary travel between centres.

For the duration of the ’lockdown’ (March - July 2020), spinal CT was utilised for the first time at our Trust, for patients who presented outside normal working hours with symptoms of CES (follow-up MRI was then performed during normal office hours).

We retrospectively reviewed our experience, including analysis of reporting accuracy by a senior MSK radiologist utilising a points-based risk assessment template. We found that there were only minor discrepancies on the CT reports, and that subsequent MRI did not reveal any additional findings over CT.

We conclude that CT spine is a safe and widely available alternative to MRI for investigating CES, but that reporting accuracy can be reduced by a lack of exposure to the technique. Our presentation would aim to improve this by providing a comprehensive teaching resource, including discussion of pearls and pitfalls of CT spine interpretation, and imaging review of relevant pathology, including CES secondary to malignancy, trauma, degenerative disease, disc herniation, and infection.
Summary: CT imaging for cauda equina is a safe and well-established technique for measuring changes in neural impingement when performed with the proper technique. Training of non-MSK/non-Neuro Radiologists to utilise a dedicated Spinal CT protocol allowed for improved reporting. The pearls and pitfalls have been described in the poster. We anticipate this service provision will be required during the second wave in the majority of non-tertiary hospitals when inter-hospital transfers become limited.
References: Dunne E. UK Health and Safety Executive. Risk Assessment Tool and Guidance . London: Health and Safety Executive. June 2008. Available online from: www/hse.gov.uk.
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