Neuron-specific enolase as a Biomarker in Nerve Compression and Cauda Equina Syndrome (BioNCCES) Study

Area of Science:

• Neurosurgery
• Diagnostic Biomarkers
• Emergency Medicine

Background:

• Cauda equina syndrome (CES) is a critical neurosurgical condition requiring immediate evaluation.
• Urgent lumbosacral spine MRI is standard for diagnosing suspected CES.
• This study investigated serum neuron-specific enolase (NSE) as a potential predictor of nerve compression severity.

Purpose of the Study:

• To determine if serum NSE levels can predict the degree of nerve compression in patients with suspected CES.
• To assess the diagnostic utility of NSE in the emergency department setting for CES.

Main Methods:

• Prospective diagnostic cohort pilot study involving adult patients presenting with CES symptoms.
• Serum NSE levels and lumbosacral spine imaging (MRI or CT) were obtained.
• Imaging was classified as positive (nerve compression) or negative based on radiological reports.

Main Results:

• 98 patients were included; 52 had positive imaging and 46 had negative imaging.
• Mean serum NSE levels were similar between groups (7.16 µg/L in positive vs. 6.82 µg/L in negative).
• NSE showed no discriminatory ability (AUC = 0.542) between positive and negative imaging results.

Conclusions:

• Serum NSE is not a useful biomarker for managing patients presenting with suspected CES symptoms.
• Current evidence does not support the use of NSE in diagnosing or assessing nerve compression in CES.