A Brief Rating Scale of Subjective Persistent Symptoms of the Cauda Equina Syndrome for Family Physicians or Medical Psychologists

Background: Case studies have shown that some persons develop an acute cauda equina syndrome from injuries to perispinal tissues and/or vertebral fractures in motor vehicle accidents (MVAs). It is of neuropsychological interest to examine if persistent subjective symptoms of injury to the area of cauda equina are present, in milder forms, even in post-MVA patients who have not sustained documented vertebral fractures, when such patients are interviewed many months after their accident. This study presents statistical data on a 5 item screening scale to measure such subjective persistent symptoms of cauda equina syndrome. This scale may be used by family physicians or by specialized medical psychologists to determine if a referral to a neurologist is warranted and necessary.

Method: Archival de-identified data on 67 Canadian patients in the Toronto area (mean age 38.8, SD=11.7; 25 men and 42 women) who survived serious MVAs were evaluated for the presence of the following 5 symptoms: (1) pathological
tingling extending over the gluteus, between the legs or on upper thighs, and over lower abdomen, (2) numbness
extending over the gluteus, between the legs or on upper thighs, and over lower abdomen, (3) reduced control over leg muscles, (4) impaired control over the urinary bladder, and (5) impaired bowel control.

Results: Frequencies of reports of moderate or severe symptoms involving these 5 items were as follows: reduced control over legs by 25.4% of patients, impaired bladder control by 18.0% of patients, tingling in lower body or legs by 16.5% of patients, impaired bowel control by 14.9% of patients, and numbness in lower body or legs by 9.0% of the patients. This 5 item scale has a satisfactory internal consistency (Cronbach’s alpha = .77) and item-total correlations. This screening scale for cauda equina syndrome has satisfactory convergent validity as shown by its significant correlations, in our sample of patients, to other subjectively reported whiplash symptoms (r=.69) and also by significant positive correlations to various ratings of pain (rs of .33 to.42), insomnia (r=.43), post-concussive symptoms as operationalized by Rivermead scores (r=.40), PTSD as measured via PCL-5 (r=.49), and depression (r=.33).