Cauda Equina Syndrome ani kɔkolo degun jugumanba Drapeaux rouges¶

Cauda Equina Syndrome (CES) ani Acute Spinal Cord Compression (Metastatic Spinal Cord Compression [MSCC] ani Spinal Epidural Abscess fana sen bɛ o la) ye opereli senfɛ-kɔrɔtɔko ye, minnu na disiki belebeleba dɔ, kurukuru, joli kurulen, walima banakisɛfagalanw bɛ kɔkolo walima kɔkolo ni kɔkolo kurukuruw mugumugu sacral nerve roots bɛ kɔkolo da la. Hali ni kɔdimi gansan kɛmɛsarada la 95 ani fan kelen sɔgɔsɔgɔninjɛ ye masinko gɛlɛya juguw ye minnu bɛ ɲɛ ni lafiɲɛbɔ ni farikoloɲɛnajɛ furakɛli ye, kɔdimi kɛmɛsarada la 5 min bɛ taa ni "Drape rouge" hakiliɲagami taamasiɲɛw ye o bɛ se ka kɛ sababu ye ka sen fila bɛɛ paralizi banbali, min tɛ se ka segin kɔ, sugunɛ ni banakɔtaa kunbɛnni bɔnɛ a si bɛɛ la (a ka kan ka kɛ ka yɛrɛkatiri kɛ walima ka kolostɔmi kɛ), ani cɛnimusoya baara bɔnɛ banbali ni opereli degun bɛ mɛn ka tɛmɛ lɛri 24 fo lɛri 48 kan. Ni aw ye lasɔmini taamasiɲɛw dɔn joona i n’a fɔ "sɔgɔsɔgɔninjɛ" (sɔgɔsɔgɔninjɛ ni aw bɛ a ko ni ɲɛgɛn papiye ye), sugunɛ sigasiga walima a tali dimi tɛ min na, walima sɔgɔsɔgɔninjɛ min bɛ jɛnsɛn sen sen fila bɛɛ la la, o bɛ a to banabagatɔw bɛ se ka dɔgɔtɔrɔso makɔnɔli sɛbɛnw tɛmɛ minnu bɛ kɛ tuma bɛɛ, ka taa ɲɛfɛ ka taa kɛnɛyaso la walasa ka MRI sɛgɛsɛgɛli kɛ tile kelen kɔnɔ ani ka kɔkolo degun opereli kɛli.

Aw bɛ o kɛ sisan¶

1. Aw bɛ teliya ka Cauda Equina Syndrome Red Flags cardinal 4 ("Saddle, Bladder, Bowel, Bilateral Legs") sɛgɛsɛgɛ. Ni kɔdimi walima sɔgɔsɔgɔninjɛ bɛ mɔgɔ min na, o tigi ye nin taamasiɲɛ ninnu dɔ la kelen sɔrɔ, aw bɛ o furakɛ i n’a fɔ opereli gɛlɛya teliya la kɛnɛyaso kɔnɔ:
2. Sɔrɔdasi Anestezi / Perineal Numbness: Sɔgɔsɔgɔninjɛ, sɔgɔsɔgɔninjɛ, "pins and needles," walima dusukunnata bɔnɛni juguba dɔ "novocaine-like" yɔrɔw la minnu bɛna maga sow ka sɔgɔli la (kɔkɔ, kɔnɔbara, kɔnɔbara, cɛya/cɛya/cɛya/musoya), a ka ca a la a bɛ kɔlɔsi ko a bɛ kɛ cogo wɛrɛ la ni a bɛ ko ni ɲɛgɛn papiye ye baara kɛlen kɔfɛ ɲɛgɛn.
3. Sugunɛbilenni: Sugunɛ daminɛ gɛlɛya (sigasiga), a ka kan ka degun ni kɔnɔbara fasaw ye walasa ka sugunɛ kɛ, a barika ka dɔgɔn walima a dɔgɔyara, a bɛ bɔnɛ a la ko sugunɛ falen don, a tɛ a ye ko sugunɛ bɛ tɛmɛ sugunɛ fɛ, walima koli tɛ se ka kɛ \(> 6\text{ fo ka se }8\text{ hours}\) ma.
4. Banakɔtaa walima cɛnimusoya baarakɛbaliya: Kɔnɔbara basigilen falen, a tɛ se ka kɔnɔbara basigilen siri, nɔgɔ bɛ kɛ balawu la/a tɛ se ka a yɛrɛ minɛ, walima cɛya ni musoya barika banna walima ka se ka cɛya/cɛya sɔrɔ.
5. Sciatique bilateral walima Progressive Sciatica / Motor Weakness: Sciatic nerve dimi, sɔgɔsɔgɔninjɛ, walima barikantanya min bɛ bɔ duguma Sen fila bɛɛ bɛ bɔ sen kelen na (walima ka wuli ka bɔ sen kelen na ka taa sen wɛrɛ la), walima senw jigin yɔrɔnin kelen (ka senna-tɛgɛrɛ kɛ barisa senkɔniw tɛ se ka kɔrɔta san fɛ) walima gɛnɛgɛnɛw bɛ wuli.
6. Aw bɛ taa dɔgɔtɔrɔsoba dɔ la min bɛ se ka MRI ni kɔkolo opereli kɛ sanga 24 kɔnɔ (walima aw bɛ 911 / 112 / 999 wele ni aw tɛ se ka taama). Aw bɛ 911 wele Ameriki ni Kanada, 112 Erɔpu tɔnba bɛɛ kɔnɔ, 999 Angletɛri, walima aw bɛ o bɛɛ lajɛ kɔrɔtɔko nimɔrɔw. AW KAN’a taa dɔgɔtɔrɔso la min bɛ se ka taama joona, furakɛli fɔlɔ biro la, walima bolokɔniw furakɛyɔrɔ la, barisa o yɔrɔw tɛ ni MRI kɔrɔtɔlen sɛgɛsɛgɛlikɛlan ye walima hakililabaarakɛla ye o yɔrɔ la, wa u bɛna lɛrɛ nafamaw tiɲɛ sani aw ka taa yɔrɔ wɛrɛ la.
7. Aw bɛ banabagatɔ mara kosɛbɛ Nothing by Mouth (NPO: dumuni, ji, walima da kɔnɔ dimifura tɛ) kabini aw bɔra dɔgɔtɔrɔso la. Ni MRI sɛgɛsɛgɛli kɔrɔtɔlen ye Cauda Equina Syndrome walima kɔkolo degun jugumanba jira, senfagabana walima kolotuguda operelikɛla bɛna taa ni banabagatɔ ye ka taa opereli yɔrɔ la walasa ka lamine/disquectomy kɔrɔtɔlen kɛ a jukɔrɔ anestezi basigilen. Dumuni dunni walima ji minni sira kan ka taa ER la, o bɛ se ka anestezi daminɛni bila kɔfɛ fo lɛri 6 fo lɛri 8.
8. AW kana kɔkolo sɛgɛsɛgɛli kɛ abada, ka bolokɔniw ladilan, ka masala juguman kɛ, ka tabali wuli ka jɛngɛ, walima ka kɔkolo kɔrɔta ni fanga ye. Ni kɔkolo disiki belebeleba dɔ, kurukuru min bɛ taa yɔrɔ wɛrɛw la, walima ni kɔkolo jolilabanaw bɛ ka digi kɔkolo walima kɔkolo sɔgɔsɔgɔninjɛ la kaban, ni aw ye kɔkolo tigɛli walima ka a ladilan, o bɛ se ka farikolojidɛsɛ tɔ minnu ma tiɲɛ, olu tigɛ ka kɛ o yɔrɔnin bɛɛ, paraplegie min tɛ se ka segin kɔ.
9. Banabagatɔ min ka kansɛri ni kɔdimi kura bɛ a la: Aw bɛ u da FLAT u kɔ kan joona. Metastatic Spinal Cord Compression (MSCC) la, kurukuruw bɛ kɔkolo kolo fanga dɔgɔya fo kɔkolo ka kɛ masinko ye min tɛ sabati. Ni i sigilen don walima ni i jɔlen don, o bɛ girinya aksidan bila kɔkolo bintɔ kan; UK NICE ka laadilikan NG234 bɛ yamaruya di ko MSCC banabagatɔ minnu bɛ siga la, olu ka to u dalen bɛ u la (u da la) fo MRI ka kɔkolo sabatili dafa.
10. Kɔrɔtɔko ɲɛmɔgɔso ka triage desk la, aw bɛ nin kumaw fɔ k’a jɛya: "Ne kɔdimi bɛ ni [sɔgɔsɔgɔninjɛ / sugunɛbilenni yeli / sen fila barika dɔgɔyali] ani ne mago bɛ jateminɛ kɔrɔtɔlen na walasa ka Cauda Equina Syndrome bɔ kɛnɛ kan." Aw bɛ darapo bilenman taamasiɲɛ kelen-kelen bɛɛ daminɛ waati tigitigi min na, aw bɛ o sɛbɛn, ani ka aw labɛn teliya la dilan kɛrɛfɛ Ultrasound Bladder Scan (ka suman sugunɛ tolen kɔfɛ) ani Kɔrɔtɔlen kɔkolo MRI.

Acute spinal red flag triage ani wale latigɛ jiri¶

Aw bɛ nin kɛnɛyaso taabolow kɛ walasa ka kɔdimi basigilen walima sɔgɔsɔgɔninjɛ min bɛ kɛ ni masin ye, o ni kɔkolo kɔrɔtɔlen naani minnu bɛ kɛ ni opereli ye (Cauda Equina Syndrome, Metastatic Spinal Cord Compression, Spinal Epidural Abscess, and Spinal Epidural Hematoma).

flowchart TD
    Start["Banabagatɔ bɛ na ni kɔ/kɔdimi ye,<br/>Sciatique, walima Sen/bolo kura barikantanya"] --> TraumaCheck{"Yala o tugura farikolo-ɲɛnajɛ fanga caman sɔrɔli kɔ<br/>(mobili boli, ka bin ka bɔ sanfɛ, ka jigin) wa?"}

    TraumaCheck -->|"ƆWƆ: Traumatisme aigu"| TraumaGuide["Aw bɛ tugu traumatic Spinal Injury Protocol kɔ:<br/>Aw bɛ kunkolo/kɔkolo lamaga layini na, aw kana banabagatɔ lamaga,<br/>Aw bɛ wele 911 / 112 / 999 (Aw ye gafe ɲɛ kɔkolo joginw lajɛ)"]

    TraumaCheck -->|"AYI: A bɛ kɛ a yɛrɛma, a bɛ wuli, walima a bɛ daminɛ dɔɔni dɔɔni"| CESCheck{"Aw bɛ Cauda Equina darapo bilenmanw lajɛ (L2 fo S4 Nɛrɛw):<br/>1. Kɔnɔbara, kɔkili, walima ko yɔrɔ la, sɔgɔsɔgɔninjɛ/sɔgɔsɔgɔninjɛ?<br/>2. Sugunɛ daminɛ gɛlɛya, jiboli barikama, walima a marali?<br/>3. Banakɔtaa/kɔnɔnatumu bɔnɛni walima cɛya ni musoya sɔgɔsɔgɔninjɛ?<br/>4. Sciatica walima barikantanya sen FILA la (walima senw jigin ka taa a fɛ)?"}

    CESCheck -->|"ƆWƆ: CES taamasiyɛn kelen o kelen"| GoER_CES["Opereli KƆRƆBƆLI KƆRƆBƆLI (CES sigalen don):<br/>1. Aw bɛ taa dɔgɔtɔrɔso ER la ni 24/7 MRI & kɔkolo opereli ye SISAN<br/>2. Aw kana foyi mara da la (NPO) walasa ka opereli teliya<br/>3. AW KAN’a kɔkolo lamaga, k’a firifiri, walima k’a sɛgɛsɛgɛ<br/>4. Aw bɛ Post-Void Bladder Scan ɲini + MRI kɔrɔtɔlen"]

    CESCheck -->|"AYI"| CordCheck{"Aw bɛ kɔkolo sanfɛla deguncogo lajɛ,<br/>Kansɛri (MSCC), walima banakisɛ (Abscess) Darapo bilenmanw:<br/>1. Kansɛri dɔnnen/tɛmɛnen + kɔdimi kura barajuru/su?<br/>2. Sumaya, farigan, fura tali IV la, walima kɔsa in na pikiri?<br/>3. Joli-minɛnw + kɔdimi barikama min bɛ i n’a fɔ muru, epidurali kɔfɛ?<br/>4. Taama ‘robo’ gɛlɛn gɛlɛn, reflexes brisk, walima disi dimi?"}

    CordCheck -->|"ƆWƆ: Kansɛri, Sumaya/Sepsis, joli segin fura,<br/>walima Sanfɛla Motɛri senfagabana taamasiɲɛw"| GoER_Cord["KƆRƆBƆLI KƆRƆBƆLI ƝƐNABƆLI KƆRƆBƆLI:<br/>1. Aw bɛ taa Kɔrɔtɔko ɲɛmɔgɔso la YƆRƆBƆLI<br/>2. Ni Kansɛri (MSCC) bɛ siga la: Aw bɛ FLAT da kɔ kan (supeni)<br/> walasa ka bana ka kari binni bali<br/>3. A mago bɛ MRI bɛɛ lajɛlen na + Dexamethasone IV (MSCC kama)<br/> walima Banakisɛfagalanw/Opereli jibɔcogo IV (Epidural Abscess kama) ."]

    CordCheck -->|"AYI: Farikolo kelen sɔgɔsɔgɔninjɛ walima kɔdimi yɔrɔ dɔ dɔrɔn,<br/>sugunɛbilenni/banakɔtaa/sɔgɔsɔgɔninjɛ bɛrɛbɛrɛ, fanga bɛrɛbɛrɛ"| RoutineSciatica["Kɔdimi masinbali gɛlɛn / Sciatique fan kelen fɛ:<br/>- A bɛ se ka furakɛ ni ladonni fɔlɔ ye & lamaga nɔgɔman<br/>- Aw bɛ aw janto kosɛbɛ Darapo bilenman ‘Safety Net’ taamasiɲɛw la don o don;<br/> aw bɛ taa ER la joona ni sɔgɔsɔgɔninjɛ walima sugunɛ taamasiɲɛ YE"]

Anatomie 101: Mun na kɔkolo ni Cauda Equina bɛ kɛ cogo wɛrɛ la¶

Walasa k’a faamu mun na degun bɛ kɔ walima kɔ cɛmancɛ la, o bɛ kɛ sababu ye ka senw gɛlɛya, ka sɔgɔsɔgɔ (Spinal Cord Compression / Myelopathy), k’a sɔrɔ kɔ duguma degun bɛ kɛ sababu ye ka senw sɔgɔsɔgɔ, ka sɔgɔsɔgɔ ani ka sugunɛbaralabana (Cauda Equina Syndrome), aw ka kan ka hadamaden kɔkolo bɛ ban yɔrɔ min na tiɲɛ na, o ye aw ɲɛ na:

1. Kɔnɔbara yɛrɛ (Kɔnɔbara ni barajuru kɔkolo bɛ jigin ka se \(L1\) ma):
2. Baliku la, cɛmancɛ kɔkolo min jɔlen don, o bɛ jigin ka bɔ kunsɛmɛ na ka tɛmɛ kɔkolo kolotuguda fɛ min bɛ kɔkolo (kɔkolo kɔkolo) ni kɔ cɛmancɛ la (kɔkolo cɛmancɛ) ani a bɛ ban kɔkolo sɔgɔlen dɔ la min bɛ wele ko conus medullaris kɔkolo fɔlɔ walima filanan lamini yɛrɛ la (\(L1\text{ ka se }L2\)), i kɔkolo duguma dɔrɔn.
3. Ikomi kɔkolo la, Sanfɛla Motɛri Neurons (central nervous system tracts) bɛ sɔrɔ, ni i ye kɔkolo mugumugu yɔrɔ o yɔrɔ k’a ta kɔ la ka jigin fo ka se \(L1\) ma, o bɛ kɛ sababu ye ka Upper Motor Neuron (UMN) taamasiɲɛw: farikolo gɛlɛnw, sirilenw, sɔgɔsɔgɔninjɛ (hypertonia), gɛnɛgɛnɛ/senkɔni reflexes teliyalenw (hyperreflexia ani clonus), senkɔni belebele min bɛ wuli ni senkɔni bɛ sɔgɔsɔgɔ (Babinski taamasiɲɛ ɲuman), taamacogo min bɛ kɛ ni "taama barajuru kan" taamacogo ye min sinsinnen don kosɛbɛ, ani layini jɛlen jɛlen min bɛ kɛ disi walima kɔnɔbara kan, fari dusukunnata bɛ dulon min jukɔrɔ (a sensory level).
4. Cauda Equina ("So ka kùnkolo", k'a ta \(L2\) la ka jigin ka se Sacrum \(S5\) ma):
5. \(L1\text{ ka taa }L2\) kɔkolo jukɔrɔ, kɔkolo gɛlɛn tɛ yen. O nɔ na, ​​nɛrɛmuguma kelen-kelen 18 (\(L2, L3, L4, L5\) ani \(S1, S2, S3, S4, S5\) numan fɛ ni numan fɛ) kulu lafiyalen, jɛgɛlen bɛ panpan kɔkolo dural foroko kɔnɔ i n’a fɔ so kɔkili (cauda equina latigɛkan na) jiriw.
6. \(L2\text{ ka se }S1\) nɛrɛmuguma bolow bɛ bɔ ka fanga di cɛya, gɛnɛgɛnɛ, senkɔniw ani senw ma.
7. \(S2, S3,\text{ ani }S4\) sacral parasympathetic nerve roots minnu ka nɔgɔn, minnu tɛ miyɛli ye, olu bɛ boli ka jigin sow kɔ cɛmancɛ la walasa ka sugunɛbilenni (detrusor contraction), kɔnɔbara/banakɔtaa lankolonya, kɔnɔbara ni sugunɛbaralabana kɔlɔsili, cɛnimusoya wulicogo/tulubɔcogo, ani farilabɔli kunbɛn "saddle" bɛɛ kɔnɔ. (kɔnɔna, cɛya, ɲɛgɛnɛsira, ani kɔkili).
8. Ikomi cauda equina bɛ kɛ ni Lower Motor Neurons (peripheral nerve roots) ye sanni ka kɛ cɛmancɛ kɔkolo ye, cauda equina (a ka ca a la ka bɔ cɛmancɛ disiki sɔgɔsɔgɔninjɛba dɔ la \(L4\text{--}L5\) walima \(L5\text{--}S1\)) la, o bɛ na ni Lower Motor Neuron (LMN) taamasiɲɛw ye: farikolo minnu bɛ sɔgɔsɔgɔ, minnu barika ka dɔgɔn (flaccid weakness), senkɔni ni gɛnɛgɛnɛ reflexes tɛ yen walima u bɛ dɔgɔya (areflexia), ani sugunɛbilenni min bɛ paralize kosɛbɛ, min bɛ sɔgɔsɔgɔ min tɛ se ka sugunɛ bɔ.

Opereli kɔkolo degun kɔrɔtɔko 4 minnu bɛ kɛ, olu sangali bɛɛ lajɛlen¶

Aw bɛ baara kɛ ni nin kɛnɛyaso tabali ye (min bɛ bɛn British Association of Spine Surgeons [BASS], UK GIRFT [Getting It Right First Time] National Suspected Cauda Equina Pathway, ani NICE Guideline NG234) walasa ka kɔkolo kɔrɔtɔlenba naani suma minnu tɛ bɔnɛ ye:

Dɔgɔtɔrɔso gafe ɲɛfɔlen don Cauda Equina Darapo bilenmanw sɛgɛsɛgɛli kan so kɔnɔ¶

Banabagatɔ minnu kɔdimi jugumanba bɛ u la, olu ka teli ka dimimadafura ta, u sɛgɛnnen don, wa u dalen tɛ a la ko u taamasiɲɛw ye “sciatica jugu dɔrɔn ye” walima ni Cauda Equina Syndrome lakika ye. Aw bɛ baara kɛ ni nin yɛrɛsɛgɛsɛgɛli duuru ye minnu bɛ se ka kɛ, kan jɛlen na (minnu sɔnna UK Chartered Society of Physiotherapy [CSP] ani National Back Pain Pathway fɛ) walasa ka aw yɛrɛ walima denbaya kɔnɔmɔgɔ dɔ jateminɛ:

1. "Wuluya papiye ko" sɛgɛsɛgɛli min bɛ kɛ ka ɲɛsin sɛgɛnlafiɲɛbɔ ma (\(S2\text{--}S5\)) .¶

Anestezi min bɛ kɛ ni sɛgɛnlafiɲɛbɔlan ye, o kɔrɔ tɛ tuma bɛɛ ko i kɔkili bɛɛ bɛ kɛ kɛmɛsarada la ka sa i n’a fɔ jiribolo. Cauda Equina Syndrome daminɛ na, a ka ca a la a tɛ ye walima a bɛ kɛ fan kelen fɛ: - Ni aw bɛ banabagatɔ ɲininka: "Ni aw sigilen bɛ ɲɛgɛn sigilan kan walima ni aw bɛ aw ko ni ɲɛgɛn papiye ye koli kɔfɛ walima banakɔtaa kɛlen kɔfɛ, yala fari min bɛ aw kɔ sira lamini (kɔnɔna), aw senw ni ɲɔgɔn cɛ (perineum), walima aw cɛya/kɔnɔna na, o fari bɛ sɔgɔsɔgɔ, ka kirin, ka bonya, ka nɛnɛ, walima i n’a fɔ ɲinw furakɛla ye novocaine pikiri kɛ aw la wa?* - A lajɛ fana: Yala sigili bɛ kɛ i n’a fɔ i sigilen bɛ fara kan, sosɛti kurulen, walima ɛponji kan bawo fari min bɛ i sigilen kolo kan, o tɛ se ka a ye ko a bɛ cogo la wa? Dusukunnata fɛn o fɛn bɛ Changé saddle zone la, o ye wajibi ye ka kɛ kɔrɔtɔko so darapo bilenman ye.

2. Ka Cauda Equina Sugunɛbilenni taamasiɲɛ 3 dɔn¶

Ikomi kɔdimi juguman bɛ mɔgɔ minnu na, olu ka teli ka u yɛrɛ tanga taama ma ka taa sanuyaso la walima ka furaw ta i n’a fɔ kodeyini/mɔrini walima gabapentin/pregabalin minnu bɛ sunɔgɔ bila u la, o la, sugunɛbaralabana bɛ ye ka ɲɛ nɔgɔya la. Yɛlɛma ninnu dɔ la kelen kɔlɔsi: 1. Dɔgɔtɔrɔso: I tɛ dusu don tuguni ko i ka sugunɛ bɛ fa, WAALIMA ni i sigilen bɛ ɲɛgɛn kan ka koli kɛ, i bɛ se ka sugunɛ bɛ ji gosi ɲɛgɛn kɔnɔ, nka tiɲɛ na, i tɛ se ka sugunɛ sumalen ye min bɛ tɛmɛ i ka sugunɛbara fɛ. 2. Motɛri sigasiga ni sɛgɛn: I bɛ jɔ walima ka sigi ɲɛgɛn na miniti kelen kɔnɔ i tɛ se ka i ka jibɔ daminɛ, i ka kan ka i gɛrɛntɛ kosɛbɛ ni i kɔnɔbara fasaw ye (Valsalva) walima ka i bolo digi i kɔnɔbara duguma walasa ka sugunɛ bɔ, walima i bɛ koli ban ka sɔrɔ o yɔrɔnin bɛɛ la i bɛ a ye ko i ka sugunɛ tilalen don hali bi. 3. Dimi tɛ min na ka sugunɛ minɛ ani ka a caya: Aw ma sugunɛ kɛ fo lɛrɛ 6 fo lɛri 8 hali ni aw bɛ ji min, OR sugunɛ misɛnniw bɛ bɔ aw ka fini kɔnɔ k’a sɔrɔ aw ma miiri ni aw ye aw jɔyɔrɔ Changer, ni aw bɛ sɔgɔsɔgɔ, walima ni aw jɔlen don (overflow incontinence ka bɔ sugunɛbara la min janyalen don, min paralize).

3. Mun na "Bilateral Sciatica" (Hali ni sɔgɔsɔgɔninjɛ tɛ) ye Darapo bilenman ye¶

Disiki kirinni min bɛ kɛ tuma bɛɛ, disiki jeli fitini dɔ bɛ wuli dɔɔni ka taa numan fɛ WAALIMA kinin fɛ, ka nɛrɛmugu ju kelen sɔgɔ ani ka kɛ sababu ye ka klasiki kɛ ni sɔgɔsɔgɔninjɛ ye min bɛ kɛ fan kelen fɛ ka jigin sen kelen na. - Nka ni banabagatɔ dɔ dimi bɛ a la, ni pinɛw ni nɛgɛw, walima ni sɔgɔsɔgɔninjɛ bɛ a sen fila bɛɛ ci ka jigin waati kelen na, WAALIMA ni a sen numanbolo sɔgɔsɔgɔninjɛ tun bɛ a la dɔgɔkun bɛɛ kɔnɔ ani ni a kininbolo senw sɔgɔsɔgɔninjɛ barika banna bi (sɔgɔsɔgɔninjɛ min bɛ ɲɔgɔn falen), o kɔrɔ ye ko cɛmancɛ disiki belebeleba dɔ bɛ ka kɔkolo cɛmancɛ bɛɛ fa ani ka a bagabaga cauda equina ka bɔgɔdaga.

4. Sekɔndi 10 dilan kɛrɛfɛ Heel-Walk ani Toe-Walk Motor Check kɛcogo¶

Ni banabagatɔ bɛ se ka jɔ lafiya la ni mɔgɔ dɔ ye a bolo ye, aw bɛ a ɲini a fɛ a ka sen 3 kɛ a senkɔniw kan ani senna 3 a senkɔniw na: - U tɛ se ka taama u senkɔniw kan (senkɔniw bɛ sɔgɔsɔgɔ duguma = "Sen jigin"): A bɛ \(L4\text{ ani }L5\) nɛrɛmugu juw degun jira min bɛ senkɔni kɔdimi (tibialis anterior muscle) ani senkɔni belebelew janya (extensor hallucis longus) kɔlɔsi. - U tɛ se ka wuli walima ka taama u SƆRƆBƆLI kan (senkɔni bɛ jigin): A bɛ \(S1\text{ ani }S2\) nɛrɛmuguma degun jira min bɛ misiden farikolo kɔlɔsi (gastrocnemius-soleus plantarflexion). - Sen fila la kelen barika dɔgɔyali teliya la, walima sen fila bɛɛ la fanga dɔgɔyali, o bɛ kɛ sababu ye ka kɔrɔtɔko ɲɛmɔgɔso ka sɛgɛsɛgɛli kɛ joona ani ka MRI kɛ, hali ni sugunɛ baara bɛ senna hali bi.

Cauda Equina Syndrome ka kɛnɛyako taabolo fila faamuyali: CES-I ni CES-R¶

Diɲɛ kɔnɔ, kɔkolo operelikɛlaw bɛ Cauda Equina Syndrome dafalen tila ka kɛ kɛnɛyaso danfaralen fila ye minnu bɛ opereli ɲɛfɔli ɲɛfɔ:

Kɔrɔtɔko kɛrɛnkɛrɛnnen minnu farati ka bon: Kansɛri (MSCC) ani kɔkolo ɲɛgɛnɛsiralabanaw¶

1. Kɔnɔbara basigilen (MSCC) banabagatɔw la minnu ka kansɛri bɛ yen sisan walima kansɛri tɛmɛnen¶

Kansɛri** banabagatɔ bɛɛ kɛmɛsarada la 5 fo 10 ɲɔgɔn (kɛrɛnkɛrɛnnenya la sin, ɲɛgɛnɛsira, fogonfogon, sugunɛ, sɔgɔsɔgɔninjɛ, sɔgɔsɔgɔninjɛ, walima miyɛloma caman) bɛ laban ka taa kɔkolo kolotugudaw la. Ni kuru dɔ falenna kɔkolo la walima ni a kɛra sababu ye ka kɔkolo fanga dɔgɔyalen dɔ bin kɔkolo kan: - Dimi bɛ na dɔgɔkun caman ka kɔn farikolojidɛsɛ ɲɛ: Banabagatɔ kɛmɛsarada la 90 ni kɔ bɛ kɔ walima kɔdimi kura walima min bɛ juguya dɔɔni dɔɔni dɔgɔkun 3 fo dɔgɔkun 8 kɔnɔ sani u senw ka barika dɔgɔya. - Classic Cancer Kɔdimi Drapeaux Rouges: 1. Dimi kɔkolo cɛmancɛ la (kɔ cɛmancɛ la kamankunw ni ɲɔgɔn cɛ) : disiki sɔgɔsɔgɔninjɛ ɲuman man teli ka kɛ barajuru la, o la kɔ cɛmancɛ dimi kura baliku la min si tɛmɛna san 50 kan walima mɔgɔ o mɔgɔ kansɛri taamasiɲɛ bɛ a la, o bɛ sigasiga fo ni a jirala ko o tɛ. 2. Sufɛ / Supine Pain: Kɔdimi gansan min bɛ kɛ ni masin ye, o bɛ fisa ni i dalen bɛ dilan kan ka lafiɲɛ. Tumu dimi min bɛ kɔkolo kɔnɔ, a ka ca a la, o bɛ juguya ni a dalen bɛ dilan kan su fɛ (ka a sababu kɛ joli siraw falenni ye kolo kɔnɔ) ka banabagatɔ kunun ka bɔ sunɔgɔ la. 3. Dimi min bɛ i n’a fɔ bandi: Dimi min bɛ a siri ka ɲɛ kɔkili walima kɔnɔbara la i n’a fɔ cɛsirilan. - Teliya la ka kɔn dɔgɔtɔrɔso ɲɛ ani ER (NICE NG234): - Ni siga bɛ MSCC la ni hakiliɲagami taamasiɲɛw bɛ a la (sen girinya, taamacogo basigilen, dusukunnataw yeli, walima sugunɛbaralabana), aw bɛ banabagatɔ da a kɔ kan joona walasa girinya kana kɔkolo fanga dɔgɔyalen mugumugu min tɛ sabati. - Aw bɛ taa kɛnɛyaso la joona walasa ka kɔkolo bɛɛ MRI kɛ sanga 24 kɔnɔ ani ka teliya ka dexamethasone hakɛ caman ta joli la (\(10\text{ ka se }16\text{ mg}\) stat) walasa ka kuru funu dɔgɔya ka bɔ kɔkolo la sani aw ka furakɛli kɛ ni fiɲɛ ye walima ka kɔkolo sabati opereli kɛ.

2. Kɔnɔbara basigilen (SEA) ani kɔkolo kɔkanna joli-sira-funu (SEH) .¶

• Spinal Epidural Abscess (SEA): Banakisɛw ka bɔrɔ min bɛ lajɛ kɔkolo kolotuguda sirilen kɔnɔ. Classic Triad: (1) Kɔkolodimi jugumanba, min bɛ kɛ yɔrɔ kelen na, min bɛ a jira, (2) Sumaya walima farigan (kɔlɔsili: sumaya tɛ banabagatɔ kɛmɛsarada la 40 la a jirali fɔlɔ la), ani (3) Farikoloɲɛnajɛ min bɛ taa ɲɛ joona. Jɔn bɛ farati la? Sukarodunbana bɛ mɔgɔ o mɔgɔ la, fari tobi kɔsa in na/selilulɛti (cellulitis) bɛ sɔrɔ, ɲinw kuru, sugunɛbaralabana, dɔrɔgu tali jolisira fɛ, joli segin furakɛli, walima kɔsa in na epidurali stɛroyi pikiri/kɔkolo pompi. Ni senw fanga dɔgɔyali daminɛna ka bɔ ɲɛgɛnɛsiralabanaw la, paraplegie dafalen min tɛ se ka segin kɔ, o bɛ se ka kɛ lɛri 6 fo lɛri 24 kɔnɔ ka da a kan kurukuruni bɛ bɔ kɔkolo joli la.
• Spinal Epidural Hematoma (SEH): Joli kurulen don kɔkolo la ni tansiyɔnba ye, a bɛ kɛ cogo kɔrɔ la ka banabagatɔ minɛ min bɛ joli furaw (warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel, walima heparin) ta, ni kɔsa in na kɔkolo sɔgɔra/epidural catheter walima a ye sɔgɔsɔgɔ/sɔgɔsɔgɔ barikama sɔrɔ yɔrɔnin kelen. A bɛ kɛ i n’a fɔ kɔdimi min bɛ kɛ yɔrɔnin kelen, i n’a fɔ muru, o kɔfɛ lɛrɛ damadɔ kɔnɔ, senw bɛ kirin ani ka sugunɛ kɛ; bɛ a ɲini ka joli segin furaw kɔsegin joona ani ka farikolojidɛsɛ furakɛ.

Fɛn min bɛ kɛ dɔgɔtɔrɔso la: Sugunɛbilenni sɛgɛsɛgɛli ani MRI kɔrɔtɔlen¶

Ni aw b’a dɔn u bɛ se ka min makɔnɔ dɔgɔtɔrɔso la, o bɛ fanga di banabagatɔw ni u somɔgɔw ma walasa u k’a lajɛ ko foyi tɛ to yen kɔrɔtɔko baarakɛyɔrɔ la, yɔrɔ min na mɔgɔw ka ca:

1. Sɛgɛsɛgɛli neurologique & Post-Void Residual (PVR) Ultrasound Sugunɛbilenni sɛgɛsɛgɛli:
2. Fɔlɔ, kɔrɔtɔko dɔgɔtɔrɔ bɛna senw fanga, u ka reflexes, ani pinprick/light-touch sensation sɛgɛsɛgɛ aw senw ni aw ka sɛgɛnlafiɲɛbɔyɔrɔ la. (Kɔlɔsili: UK BASS/GIRFT ka bi laadilikanw b’u sinsin a kan ko sɛgɛsɛgɛli nizɛrikan na [DRE] walasa ka kɔnɔbara ton lajɛ, o sɛgɛsɛgɛli ka dɔgɔn kosɛbɛ a yɛrɛ ma; ni "kɔnɔna sɔgɔsɔgɔcogo nɔgɔman" bɛ a la, o bɛ TƐ bɔ Cauda Equina Syndrome la, wa MRI kɛli wajibiyalen don hali bi ni darapo bilenmanw bɛ yen tuma o tuma.)
3. O kɔfɛ, a bɛna ɲini aw fɛ aw k’a ɲini ka aw ka sugunɛ lankolonya pewu ɲɛgɛn na, ani dɔgɔtɔrɔso baarakɛla dɔ bɛna ultrasound bere dɔ bila aw kɔnɔbara duguma dimi tɛ min na o yɔrɔnin bɛɛ walasa ka aw ka Post-Void Residual (PVR) sugunɛ hakɛ suman. Volume residual post-void ka tɛmɛ \(200\text{ mL}\) kan (ani kɛrɛnkɛrɛnnenya la \(> 400\text{ ka se }500\text{ mL}\)) ye laɲini taamasiyɛn barikama ye min bɛ sugunɛbaralabana minɛ ni hakili ye, k’a sɔrɔ PVR \(< 100\text{ ka se }200\text{ mL}\) ma, o bɛ bɔgɔbɔli lakananen jira (hali n’a ta CES-Incomplete bɛ se ka kɛ hali bi ni PVR dɔgɔyali ye ni sɔgɔsɔgɔninjɛ walima sɔgɔsɔgɔninjɛ fila bɛ yen).
4. MRI Scan kɔrɔtɔlen sanulama (A tɛ kɛ X-Ray walima CT gansan ye):
5. Kɔnɔbara basigilen X-ray tɛ se ka disiki, nɛrɛmuguma walima kɔkolo ye fewu, wa CT scan standard minnu tɛ danfara ye, olu tɛ se ka kɛ kɛmɛsarada la 30 fo 50 ye farikolo yɔrɔ nɔgɔlenw cauda equina degunw ni epidural abscesses. Magnetic Resonance Imaging (MRI) min bɛ kɛ kɔkolo/kɔkolo bɛɛ la, o ye sanu-standard diagnostic test wajibiyalen ye. (Ni banabagatɔ dɔ ka pacemaker walima metal shrapnel bɛ a la min tɛ MRI kɛ, dɔgɔtɔrɔw bɛ CT Myelogram kɛ joona.)

Kumaɲɔgɔnya sɛbɛn tigitigi dɔgɔtɔrɔso triage ni EMS kama¶

Ikomi kɛnɛyaso kɔrɔtɔlenw bɛ kɔdimibanabagatɔ tan ni caman ye baarakɛwaati o baarakɛwaati o baarakɛwaati, n’i y’i ka Drapo bilenmanw kɛrɛnkɛrɛnnenw fɔ ka jɛya triage tabali la, o b’a to i kana bila makɔnɔyɔrɔ sigilan kan min tɛ fɔlɔ ye lɛrɛ caman kɔnɔ:

"Ne bɛ yan ni kɔ/sen dimi juguman ye min daminɛna [Date] la, nka [Exact Time Today] la, ne ye [nɔgɔsɔgɔninjɛ sɔrɔ ne ka sɔgɔsɔgɔninjɛ/kɔkolo yɔrɔ la ni ne bɛ ko / gɛlɛya bɛ ne ka sugunɛ bɔli daminɛ na / sɔgɔsɔgɔninjɛ ani fanga dɔgɔyali ne sen FILA la / kansɛri tariku ni taama sabatibali kura ye]. Ne haminanko ye Cauda Equina Syndrome [walima Acute Spinal Cord Compression] ani mago bɛ teliya la sugunɛbilenni kɔfɛ ani MRI jateminɛ kɔrɔtɔlen Ne ye ne yɛrɛ mara Nothing by Mouth (NPO) ni ne mago bɛ opereli la bi."

Ɲininkali minnu bɛ kɛ tuma caman na¶

Ni ne tɛ n yɛrɛ ɲigi (incontinent), yala o kɔrɔ ye ko Cauda Equina Syndrome tɛ ne la wa?¶

Ayi, sugunɛbaralabana makɔnɔni ye kun kelen ye min ka teli ka kɛ sababu ye banabagatɔw bɛ fili finɛtiri la walasa ka opereli dafalen sɔrɔ. Ikomi Cauda Equina Syndrome bɛ nɛrɛmuguma minnu bɛ sugunɛbara digidigi, olu paralize, sugunɛ taamasiɲɛ fɔlɔ ye tiɲɛ na sugunɛ sigasiga ye, jiboli barikama, sugunɛ falenbaliya, walima sugunɛ tɛ se ka koli kɛ (a marali) ji bɔli yɛrɛ (overflow incontinence) bɛ kɛ kɔfɛ kosɛbɛ dɔrɔn ni sugunɛbaralabana sɔgɔlen don ka se a seko ma, o waati la, a ka ca a la, farikolojidɛsɛ banbali kɛra kaban.

Yala kɔkolo lajɛ tuma bɛɛ walima CT scan standard bɛ se ka Cauda Equina Syndrome bɔ a la wa?¶

Ayi, kɔkolo gansan X-ray bɛ kolo gɛlɛn dɔrɔn de jira, wa a tɛ se ka disiki kirinni ye, farikolojidɛsɛ jirisunw, ɲɛgɛnɛsiralabanaw, walima kɔkolo kuruw ye fewu. Hali CT scan standard min tɛ danfara ye, o bɛ se ka disiki nugulenw ka sɔgɔsɔgɔninjɛ belebelebaw sɔrɔ walima kɔkolo degun joona; kɔkolo MRI sɛgɛsɛgɛli kɔrɔtɔlen (walima CT miyɛlogramme ni furakɛlifɛn dɔ bɛ aw bolo min tɛ se ka don MRI la) o dɔrɔn de ye sɛgɛsɛgɛli ye min bɛ se ka da a kan walasa ka Cauda Equina Syndrome sɛgɛsɛgɛ walima ka a ban.

Mun na dɔgɔtɔrɔ y’a fɔ n ye ko n kana dumuni kɛ walima ka fɛn min min n ka taa kɛnɛyaso la, kɔdimi kosɔn ni nɛgɛso sɔgɔsɔgɔninjɛ ye?¶

Ni aw ka MRI sɛgɛsɛgɛli kɔrɔtɔlen y’a jira ko Cauda Equina Syndrome walima kɔkolo degun jugumanba, kɔkolo operelikɛla dɔ ka kan ka taa ni aw ye opereli yɔrɔ la ka ɲɛ walasa ka opereli kɔrɔtɔlen kɛ degun bɔli la anestezi basigilen na. Ni dumuni walima ji bɛ aw kɔnɔbara la, ni aw ye aw bila anestezi basigilen na, o bɛ fɔɔnɔ faratiba lase aw fogonfogon la (aspiration), o bɛ se ka dɔgɔtɔrɔw wajibiya ka aw ka kɔkolo opereli bila kɔfɛ lɛri damadɔ kɔnɔ.

Yala farati tɛ ka taa ɲɛgɛnɛsiralabanaw, kolotugudaw walima farikoloɲɛnajɛla dɔ fɛ walasa ka kɔkolo ladilan ni ne ye sɔgɔsɔgɔninjɛ fila walima kɔkolo sɔgɔsɔgɔ wa?¶

Ayi, kɔkolo fɛn o fɛn bɛ kɛ, ka teliyaba ladilan, ka tabali sama ka wuli, walima ka a senw kɔrɔta ni fanga ye, o man kan ka kɛ tuma o tuma ni darapo bilenman taamasiɲɛ dɔ bɛ yen tuma o tuma (i n’a fɔ sɔgɔsɔgɔninjɛ/banakɔtaa caman cili, sɔgɔsɔgɔninjɛ min bɛ kɛ fan fila fɛ, senw jiginni dɔɔni dɔɔni, sumaya, walima kansɛri tariku). Ni aw ye kɔkolo labɛn min ka disiki cɛmancɛ sɔgɔsɔgɔninjɛba bɛ a la kaban walima kuru min bɛ digi kɔkolo kan walima kɔkolo kan, o bɛ se ka nɛrɛmuguma tɔw mugumugu o yɔrɔnin bɛɛ ani ka kɛ sababu ye ka mɔgɔ farikolo tiɲɛ kudayi.

Sosow sɛgɛsɛgɛra¶

• British Association of Spine Surgeons (BASS), Society of British Neurological Surgeons (SBNS), ani NHS England GIRFT (Getting It Right First Time) Program (Royaume-Uni): Jamana ka siga bɛ Cauda Equina Syndrome (CES) sira (2023/2024 bɛnkansɛbɛnw ka ɲɛsin darapo bilenman dɔnni ma, sugunɛ tolenw sɛgɛsɛgɛli kɔfɛ dakunw, ani sanga 4 kɔnɔ MRI kɔrɔtɔlen jiginni).
• Jamana ka kɛnɛyako ni ladonniko ɲɛtaa baarada (NICE, Angletɛri): Kɔnɔbara basigilenw ni kɔkolodimi min bɛ taa yɔrɔ wɛrɛw la: Sɛgɛsɛgɛli ni a furakɛcogo (NICE ka laadilikan NG234, sigili sen kan ni a bɛ siga la ko MSCC tɛ sabati, sanga 24 kɔnɔ MRI, ani dexamethasone protocoles) ani Kɔnɔdimi ni sɔgɔsɔgɔninjɛ ni u si tɛmɛna san 16 kan: Jateminɛ ni Ɲɛnabɔli (NG59).
• Amerika ka kɛnɛyako kalanso (ACR) ani Ameriki woroduguyanfan kɔkolo tɔnba (NASS, Ameriki): ACR bɛnnenya sariyaw: Kɔdimi duguma ani kɔkolo degun jugumanba / Cauda Equina Syndrome.
• Société charterée de physiothérapie (CSP) ani Association des physiothérapies chartered musculoskeletal (MACP, Angletɛri): Cauda Equina Syndrome Credit-Card Red Flag Safety Net Patient Information Guide.
• Sɛbɛnnikɛlaw ka lajɛba (CNS) ani Ameriki hakililabaarakɛlaw ka tɔnba (AANS, Etazuni): Dɔgɔtɔrɔso baarakɛcogo laadilikanw opereli decompression waati kan Cauda Equina Syndrome (CES-Incomplete vs. CES-Retention) ani Spinal Epidural Abscess.

Gafe minnu bɛ tali kɛ o ko la¶

• Kɔkolo joginw : kɔ ni kɔ jɔli min bɛ kɛ ni jogin ye
• Autonome dysreflexie kɔkolo joginw ladonni kɔrɔtɔlen na
• Kolow karilen, kari, ani kurukuruw dɛmɛ fɔlɔ
• Atɛki dɔnni (FAST) ani kɔrɔtɔko jaabi
• Sepsis ni septic shock dɔnni