From hospital discharge to long-term care: Unmet rehabilitation needs in cauda equina syndrome patients from a national UK cohort.

Objectives: Although long term disability may be a consequence of cauda equina syndrome (CES), the evidence base for the effect of rehabilitation or different rehabilitation strategies is lacking. Our aim was to understand long term neurological deficits (understood as rehabilitation needs) and current rehabilitation provision for patients with CES. Methods: We retrospectively analysed data from a large UK wide cohort of CES patients presenting between 1st June 2018 and 31st May 2019. Rehabilitation referrals and attendance were described, and symptoms at discharge and one year were identified as potential targets for rehabilitation. Results: Physiotherapy was the most common inpatient rehabilitation service accessed following surgery for CES (572/610, 94%). Few patients were referred to specialist spinal rehabilitation services at discharge (49/608, 8%). At one year follow up there were high rates of residual symptoms (motor (66%), bladder (20%), bowel (17%), and sexual dysfunction (13%)). There was a significantly higher level of ongoing bladder dysfunction in females (27%) compared with males (11%) despite similar levels at presentation (females 84% vs males 82%). Conclusion: Referral to specialist spinal rehabilitation following CES surgery is not routine in the UK but a notable proportion of patients have ongoing symptoms at one year following surgical decompression. Prospective studies of rehabilitation strategies following surgery for CES are needed to guide treatment decisions and optimise post-surgical outcomes.