Katie Knapton reviews a 'must buy' book on cauda equina syndrome, written by two physios

Cauda Equina Syndrome: The MSK clinician’s guide

Authors: Tom Jesson and Rob Tyer

Price: £25

To order a copy, visit: https://thecesbook.com/?s=03

This book is written two experienced physiotherapists: Tom Jesson and Rob Tyer. Many people with cauda equina syndrome (CES) arrive in physio departments with back pain and one or more of the following symptoms: bladder dysfunction; bowel dysfunction; reduced sensation in saddle area and sexual dysfunction. The most common presentations are due to an intervertebral disc but it can be caused by anything pressing on the cauda equina.

The need for more help in making a diagnosis and clinician education is twofold. First, there can be a huge effect on patients’ lives if a diagnosis is missed. Second, there is a risk of litigation. In a paper published earlier this year in BMJ Open, Gillian Yeowell and colleagues reported that of the 5,2496 CES claims found in the UK from 2012 to 2020, 51 were attributed to physiotherapists and the numbers are potentially much higher. See: https://bmjopen.bmj.com/content/12/7/e060023

Is this book useful?

Absolutely. It is a surprisingly easy read – though not quite a thriller! – and can be read in one go or dipped into in stages. There is a comprehensive index, and the points are well referenced. The anatomy of the cauda equina is highlighted and we learn that only an MRI scan can guarantee an accurate diagnosis. There are some case studies which help to bring the content to life, and each presenting symptom is discussed.

The difficulty of the personal nature of the questions and symptoms you need to ask to develop a clear (or as good as you can get) picture of CES is covered really well as these are the conversations we need to have and be confident about having. Clinicians are reminded to ‘keep it simple’ in terms of language and to alter their approach to suit the individual patient. This is vital as it is all about that subjective presentation.

The authors also cover various red herrings with the use of a CUSP mnemonic for when people are on the cusp of a referral to A&E. C: constipation, which may be due to medication, U-urinary tract infection, S- sex male/female, P-pain stress/anxiety. We are reminded to explore how the symptoms have behaved over time, which can affect the urgency of the referral.

I would highly recommend this book for all practitioners. It will help practitioners to produce a well-reasoned and clear referral for imaging, when required

Highly recommended

In summary, I would highly recommend this book for all practitioners. It will help practitioners to produce a well-reasoned and clear referral for imaging when required. Having as much knowledge as possible and improving confidence is vital to ensure we do not overlook this presentation, which can have lifelong consequences for our patients.

Safety netting (there are different levels and up to individual clinician's choice on what is appropriate or not) and clear communication are key messages from this book. It supplements the previous work that Sue Greenhalgh, Laura Finucane and Chris Mercer did and the excellent cauda equina safety cards (https://www.macpweb.org/Cauda-Equina-Information-cards), which I would also recommend to help the safety netting process. The importance of clear documentation on what has been discussed is stressed, and there are some useful examples of what this should look like.

So, in summary, this is a ‘must buy’ book, which contains all the information you need to be aware of CES and looking after your patients, plus avoiding potentially unpleasant litigation.

Katie Knapton is a private practitioner who runs a physiotherapy clinic and an online clinic. For more information, visit: www.physiofastonline.co.uk

Katie is a member of AGILE, a CSP-endorsed professional network for the CSP physiotherapists working with older people. Visit: https://agile.csp.org.uk/content/about-agile

To read an earlier PhysioUpdate article on this topic, visit: https://www.physioupdate.co.uk/learning-zone/two-physiotherapists-write-book-tackling-the-notoriously-difficult-topic-of-cauda-equina-syndrome-/