Tests
1st tests to order
MRI lumbar spine without IV contrast
Test
Preferred imaging investigation in the evaluation of suspected CES because of its ability to accurately depict soft-tissue pathology, assess vertebral marrow, and assess the spinal canal patency.[15]
MRI lumbar spine without and with IV contrast may be helpful to delineate etiology of CES when underlying malignancy, infection, or inflammation is suspected.[4][15]
Result
visualization of lesion and compression of neural structures
CT lumbar spine without IV contrast
Test
Should be carried out only if MRI is unavailable or contraindicated.
Can delineate whether or not cauda equina compression is present, but is less precise than MRI at characterizing the etiology of CES.[15]
Result
visualization of lesion and compression of neural structures
Tests to consider
CT myelography of the lumbar spine
Test
Assesses the patency of the spinal canal/thecal sac, and the subarticular recesses and neural foramen. It can be useful for surgical planning in patients with CES.[15] Lumbar puncture in the lower segments may exacerbate CES.
Result
shows degree of cord compression
urodynamic testing
Test
Can be used to evaluate the degree and cause of sphincter dysfunction. For example, retention and completeness of bladder emptying can be assessed using ultrasound.[33][35] However, urodynamic testing may not be practical in an emergency setting, and must not delay surgery.[4][32]
May also be useful for monitoring recovery of bladder function after decompression surgery.
Result
reduced bladder contractility; sphincter dysfunction
digital rectal exam
Test
May provide additional information, be helpful in determining the severity of injury, and help guide bowel and bladder programs.[27][28] Assess for contraindications (e.g., immunocompromised state, recent anal surgical intervention) before performing the exam.[29]
Result
patulous sphincter, reduced tone
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