title: Assessment of cauda equina syndrome progression pattern to improve diagnosis.
abstract: METHODS
  Meta-analysis of individual patient data.
  
  
  OBJECTIVE
  To date, the progression pattern of cauda equina syndrome (CES) has not been summarized. This study assessed individual patient data from CES cases, investigated the CES progression pattern to help clinicians provide timely diagnoses.
  
  
  BACKGROUND
  Because there were few randomized controlled trials about CES, our research was based on case reports of CES with detailed medical history.
  
  
  METHODS
  We searched English literature regarding CES in the PubMed database. We included a total of 198 publications involving 264 cases that met the inclusion criteria. The occurrence order of symptoms was determined by reviewing patients' medical histories, and the progression pattern of CES was analyzed using sequential pattern mining. Finally, we summarized and reassessed the current timing of CES diagnosis.
  
  
  RESULTS
  Result of sequential pattern mining demonstrated that the progression process of CES could be divided into 3 stages: early stage of CES (CESE), with bilateral peripheral nerve dysfunction characterized by progressive sensory-motor defects from unilateral to bilateral in lower extremities; incomplete CES, with reduction of sphincter functions; and CES in retention, with sphincter dysfunction. Among all the cases, 81.08% (180 cases) were diagnosed at the stage of incomplete CES or CES in retention, in which 99.4% (179 cases) had experienced CESE without being diagnosed.
  
  
  CONCLUSIONS
  The characteristic progressive sensory-motor CESE defects in lower extremities marked CES onset. Instead of waiting for the onset of sphincter function abnormalities, CES should be diagnosed when the CESE symptoms manifest.
authors.affiliation: *Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, P. R. China; and †Center for Clinical Epidemiology and Evidence-Based Medicine, Second Military Medical University, Shanghai, China.
authors.forename: Jing-Chuan
authors.initials: JC
authors.lastname: Sun
authors.forename: Tao
authors.initials: T
authors.lastname: Xu
authors.forename: Ke-Fu
authors.initials: KF
authors.lastname: Chen
authors.forename: Wei
authors.initials: W
authors.lastname: Qian
authors.forename: Kun
authors.initials: K
authors.lastname: Liu
authors.forename: Jian-Gang
authors.initials: JG
authors.lastname: Shi
authors.forename: Wen
authors.initials: W
authors.lastname: Yuan
authors.forename: Lian-Shun
authors.initials: LS
authors.lastname: Jia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011128:Polyradiculopathy / Q000175:diagnosis* / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult