Does rectal examination have any value in the clinical diagnosis of cauda equina syndrome?

Abstract

Purpose. This study aims to quantify the value of digital rectal examination (DRE) in the clinical diagnosis of cauda equina syndrome. Methods. A retrospective case note review was performed on all patients referred to a University Teaching Hospital over a one-year period with documented suspicion of cauda equina syndrome. All Patients underwent MRI scanning to either confirm or rule out the diagnosis. Results. Fifty-seven such patients were identified, 13 (23%) of whom had confirmation of cauda equina syndrome on MRI scanning. The DRE did not significantly discriminate for the outcome of MRI (p = 0.897, test accuracy 51%, diagnostic odds ratio 1.42). There was no correlation between the cumulative number of positive clinical findings in an individual patient and the likelihood of MRI diagnosis and no significant link between any individual clinical feature and the MRI result. Conclusions. Digital rectal examination has no significant value in the acute diagnosis of cauda equina syndrome. This study further confirms that there is no discreet clinical protocol applicable with which to confidently confirm or rule out this diagnosis. DRE is traditionally enshrined as an essential facet of clinical assessment in suspected cauda equina syndrome but it cannot be used as a discriminator to ration urgent MRI scanning.

Keywords::

• cauda equina syndrome
• diagnosis
• digital rectal examination
• magnetic resonance imaging
• spinal cord compression

Acknowledgements

The support of Mr D Klezl and Mr R Bombireddy, both spinal surgeons at our institution, was invaluable in the completion of this work.

Declaration of interest: The author reports no declarations of interest. The authors alone are responsible for the content and writing of the paper.