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Secondary Spinal Cord Injury llI: Pathophysiology01:25

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Early Ischemia and Ionic ImbalanceWithin minutes of spinal cord injury, a secondary cascade begins, progressing over hours to weeks. Vascular damage reduces blood flow, causing ischemia and mitochondrial dysfunction. ATP depletion leads to ion pump failure, membrane depolarization, sodium influx, potassium efflux, and water accumulation, resulting in cellular swelling. Increased intracellular calcium further disrupts mitochondria and accelerates cellular injury.Excitotoxicity and Neuronal...
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Spinal cord injury progresses through two interconnected phases: primary injury and secondary injury.Primary InjuryPrimary injury happens at the moment of trauma and involves immediate mechanical damage to the spinal cord.Compression happens when broken vertebrae, herniated discs, or accumulating blood (such as a hematoma) press directly against the spinal cord, distorting its normal shape and function. In cases of contusion, the cord is bruised by a blunt force (like penetrating injuries or...
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Cauda Equina Syndrome-A 2025 Narrative Review.

Andreas Conte1, Rishabh Jain1, Aranghan Lingham2

  • 1Department of Trauma and Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, SE1 9RT London, UK.

British Journal of Hospital Medicine (London, England : 2005)
|April 29, 2026
PubMed
Summary
This summary is machine-generated.

Cauda Equina Syndrome (CES) is a surgical emergency requiring prompt diagnosis and treatment to prevent permanent disability. This review updates management guidelines, emphasizing standardized red flag symptoms and aiming for 24-hour MRI diagnostics.

Keywords:
cauda equina syndromedecompressionintervertebral disc herniationmagnetic resonance imagingspinal cord compression

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Area of Science:

  • Neurology
  • Neurosurgery
  • Emergency Medicine

Background:

  • Cauda Equina Syndrome (CES) is a critical condition resulting from lumbosacral nerve root compression.
  • Delayed diagnosis and treatment of CES can lead to severe, irreversible neurological deficits.

Purpose of the Study:

  • To provide a 2025 update on the diagnosis and management of CES, incorporating the latest UK guidelines.
  • To outline a management pathway for suspected CES in district general hospitals without 24-hour MRI facilities.

Main Methods:

  • This narrative review synthesizes current literature and the UK's 2025 Getting It Right First Time (GIRFT) pathway.
  • Analysis of key changes in diagnostic criteria, imaging protocols, and treatment timelines for CES.

Main Results:

  • Updated guidelines standardize red flag symptoms and emphasize bladder scans as a rule-in investigation.
  • The review advocates for 24-hour MRI capabilities and urgent surgical decompression (within 24 hours) for confirmed CES.
  • A proposed pathway addresses management in hospitals lacking 24-hour MRI.

Conclusions:

  • Implementing standardized protocols and timely interventions is crucial for improving outcomes in CES patients.
  • The updated guidelines aim to reduce diagnostic delays and ensure appropriate surgical management for CES.