ArticleBone & joint open2026
Luton cauda equina syndrome pathway: a pragmatic approach to achieve a national target of time to scan in UK district general hospitals.
Article in Bone & joint open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Aims: Cauda equina syndrome (CES) is a rare neurosurgical emergency where diagnosis and treatment by emergency spinal decompression is time critical. A national CES pathway from Getting It Right First Time (GIRFT) suggested development of 24/7 MRI services at district general hospitals (DGHs). It gave a national target of time to scan time between MRI scan request and actual scan of less than four hours. The Luton CES pathway was introduced in 2021 at Luton and Dunstable University Hospital, UK, to improve the time (in hours) to a MRI service, as well as to streamline patient care for suspected CES. It aimed to improve time to scan and reduce need of out-of-hours transfer to tertiary centre for urgent MRI scan. Methods: A retrospective review of patients who presented with suspected CES before (2018) and after (2024) the introduction of the pathway in Luton and Dunstable University Hospital. The time to scan was the primary outcome measure. Secondary outcome measures were number of patients scanned, scan positive rate (patients with actual CES who underwent emergency spinal decompression), patients meeting the national target of time to scan, and the number of patients needing out-of-hours transfer to tertiary centre for urgent MRI scan. Results: The median time to scan improved from 8 hours 48 minutes to 34 minutes (p < 0.001). The number of patients scanned increased more than two-fold from 280 to 688. Patients meeting the national target increased from 66% to 90%. The number of patients also needing out-of-hours transfer reduced more than 50% from 17 to six. Conclusion: A local dedicated pathway can achieve national targets, and reduce need for out-of-hours transfer to a tertiary centre for urgent MRI scan. This is achieved by efficient use of an existing in-hours MRI service, already available in every DGH of UK. This can be the pragmatic way forward for most DGHs until they establish a 24/7 MRI service.
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