Search

This study evaluated the impact of the Salisbury Protocol for Assessment of Cauda Equina Syndrome (SPACES) on the waiting time for MRI in patients presenting with suspected Cauda Equina Syndrome (sCES) within a UK district general hospital. All consecutive patients undergoing an MRI scan in our hospital, for sCES, over a 12 month period, prior to and following the introduction of SPACES, were identified. Patient's gender, age, MRI diagnosis, time from MRI request to imaging and outcome were recorded. In the year prior to the introduction of SPACES, 66 patients underwent MRI for sCES, out of which 10.6% had cauda equina compression (CEC), 63.5% had other spinal pathology and 25% had a normal scan. In the year after introduction of SPACES, 160 patients underwent MRI for sCES out of which 6.2% had CEC, 70.7% had other spinal pathology and 23% had a normal scan. Despite the referrals for sCES increasing by more than 2-fold following the introduction of SPACES, the median time from MRI request to scan decreased from 9.1 to 4.2 hours (p = 0.106, Mann-Whitney-U) and the number of patients transferred to the regional hub hospital decreased from 7 to 3. Implementation of SPACES for patients with sCES resulted in a substantial reduction in waiting time for MRI and decreased the number of transfers to the regional hub hospital. Based on our early experience, we encourage other centres within the UK to introduce such a pathway locally, to improve the management of patients with sCES. [ABSTRACT FROM AUTHOR]

A 27-year-old rugby player underwent anterior cruciate ligament (ACL) reconstruction, using autograft. Postoperatively, septic arthritis was missed due to atypical presentation but diagnosed 2 days later and underwent open arthrotomy and lavage, He received antibiotics for 5 weeks. Aspirate showed clostridium perfringens. Later, extension lag was developed, which improved by arthroscopic excision of fibrous tissue and adhesions. The source of clostridial contamination remained a mystery. Skin preparation can be ineffective in eradicating clostridium perfringens prior to procedures. Routine prophylactic use of metronidazole would be controversial. In patients with postoperative infections, we suggest that samples should be routinely sent for anaerobic cultures.