• R Dineth Fonseka, Sayan Biswas, Hamza Ahmed, Ved Sarkar, Joshua MacArthur, and K Joshi George.
• Faculty of Medicine, University of New South Wales, Sydney, Australia.
• World Neurosurg. 2024 Sep 11.

ObjectiveCauda equina syndrome (CES) is diagnosed both clinically and radiologically. However, it's unclear if a specific degree of cauda equina compression on imaging can confirm the diagnosis. This study aimed to identify an optimal percentage of prolapse to canal ratio (PCR) on magnetic resonance imaging that correlates with cauda equina compression, facilitating reliable decision-making for CES symptoms.MethodsA single-center retrospective case series analysis was conducted from 2020 to 2021. Sixty-one patients who underwent emergency lumbar discectomy within 48 hours of presentation were included, divided into a CES group and a disc prolapse group. CES cases were identified using International Classification of Diseases, 10th Revision code G83.4. PCR was calculated by dividing the width of the disc herniation by the total width of the spinal canal at the level of the herniation on single mid-sagittal T2 magnetic resonance imaging scans, using the IC Measure software on Windows.ResultsCES most frequently occurred at the L4/5 level (37/61). The median PCR in CES cases was 76.19% (66.67-85.71), significantly higher than in disc prolapse cases, 48.08% (31.33-55.56) (P < 0.001). A PCR threshold of 40% maximized sensitivity at 100% but had a specificity of 45%. Conversely, a threshold of 75% maximized specificity at 100% with a sensitivity of 50%. The optimal PCR, determined by the Youden index, was 66%, yielding a sensitivity of 75% and specificity of 97%, with an area under the curve of 0.923.ConclusionsSimple radiological measurements of PCR can potentially triage CES patients and guide their management. Future studies should correlate PCR with clinical signs and symptoms for a comprehensive assessment.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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