{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T09:42:43Z","timestamp":1793094163786,"version":"4.5.0"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T00:00:00Z","timestamp":1683158400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Systematic review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To conduct a systematic review identifying existing definitions of cauda equina syndrome (CES) and time to surgery in the literature for patients with CES.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic review was conducted in accordance with the PRISMA statement. Ovid Medline, Embase, CINAHL Plus, and trial registries were searched from October 1\n                      <jats:sup>st<\/jats:sup>\n                      , 2016, to 30\n                      <jats:sup>th<\/jats:sup>\n                      December 2022, and combined with articles identified from a previous systematic review by the same authors (studies published 1990\u20132016).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 110 studies (52,008 patients) were included. Of these only 16 (14.5%) used established definitions in defining CES, including Fraser criteria (n = 6), British Association of Spine Surgeons (BASS) (n = 5), Gleave and MacFarlane (n = 2), and other (n = 3). Most reported symptoms were urinary dysfunction (n = 44, 40%%), altered sensation in the perianal region (n = 28, 25.5%) and bowel dysfunction (n = 20, 18.2%). Sixty-eight (61.8%) studies included details on time to surgery. There was an increase in percentage of studies defining CES published in the last 5 years compared to ones from 1990\u20132016 (58.6% vs 77.5.%,\n                      <jats:italic>P =<\/jats:italic>\n                      .\n                      <jats:italic>045<\/jats:italic>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite Fraser recommendations, substantial heterogeneity exists in reporting of CES definitions, and a start point for time to surgery, with most authors using self-defined criteria. A consensus is required to define CES and time to surgery, to allow consistency in reporting and study analysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0285006","type":"journal-article","created":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T14:01:01Z","timestamp":1683208861000},"page":"e0285006","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Definition and surgical timing in cauda equina syndrome\u2013An updated systematic review"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7703-0174","authenticated-orcid":true,"given":"Mohammad A.","family":"Mustafa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5610-451X","authenticated-orcid":true,"given":"George E.","family":"Richardson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9153-3077","authenticated-orcid":true,"given":"Conor S.","family":"Gillespie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdurrahman I.","family":"Islim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Wilby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisaharan","family":"Srikandarajah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,5,4]]},"reference":[{"issue":"2","key":"pone.0285006.ref001","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/02688690701317144","article-title":"Cauda equina syndrome: what is the correlation between clinical assessment and MRI scanning?","volume":"21","author":"DA Bell","year":"2007","journal-title":"Br J Neurosurg"},{"issue":"17","key":"pone.0285006.ref002","doi-asserted-by":"crossref","first-page":"E1005","DOI":"10.1097\/BRS.0000000000002605","article-title":"Outcomes Reported After Surgery for Cauda Equina Syndrome: A Systematic Literature Review","volume":"43","author":"N Srikandarajah","year":"2018","journal-title":"Spine (Phila Pa 1976)"},{"key":"pone.0285006.ref003","doi-asserted-by":"crossref","first-page":"n32","DOI":"10.1136\/bmj.n32","article-title":"Cauda equina syndrome","volume":"372","author":"K. 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