Pan Canada Collaboration Investigates Traumatic Cauda Equina Injury
An interest in learning more about Traumatic Cauda Equina Injury (TCEI), a relatively rare condition, led to a collaboration of researchers from across Canada.
The most common causes of TCEI include a ruptured disk, stenosis, a spinal infection, hemorrhage, fracture or a complication from a severe spine injury such as a car crash, fall, or stabbing.
“These are injuries below the spinal cord,” said Dr. Najmedden Attabib, a neurosurgeon at Horizon Health Network and an assistant professor at Dalhousie University. “That’s where the Cauda Equina is – it sits below the level of the L1 vertebra. In layman’s terms, it’s a fluff of nerves that sits below the level of the spinal cord, or resembles a horsetail.”
The research team was inspired to look into TCEI as the limited amount of information available about this injury made it challenging to answer questions regarding patient outcomes and best practices for this specific diagnosis.
The team is made up of professionals from different specializations and hospitals from across Canada. Team members from Atlantic Canada include Attabib, the Canada East Spine Centre Team, Dr. Colleen O’Connell, and Dr. Sean Christie; from the West Coast, Carly S. Rivers and Dilnur Kurban; from Central Canada, Dr. Christopher S. Bailey, Heather Flett, Dr. Julio C. Furlan; Dr. Eve C. Tsai, and the Praxis Spinal Cord Institute Team; and from the Prairies, Dr. Karen Ethans. The funding for the project comes from The Praxis Spinal Cord Institute.
TCEI can involve a complex array of symptoms that can include low back pain, leg pain, lower extremity weakness and impaired bowels and bladder.
“We cannot really extrapolate the data from spinal cord injuries and apply it to TCEI, because anatomically it’s just not a spinal cord injury,” said Attabib.
The research team had the goal of improving the ability to predict patient outcomes to better inform patients and their families on their condition. The significant impact of bowel and bladder outcomes on patient quality of life underlines the importance of finding predictors and managing expectations associated with these functions.
To do this, “we analyzed data extracted from the Praxis Spinal Cord Injury Registry Database,” said investigator Dr. Colleen O’Connell, of Stan Cassidy Centre for Rehabilitation in Fredericton.
“Praxis has 30 sites across the country with data having been collected from consented spinal cord patients over almost a 10-year period. This data can then be interpreted for investigators and researchers to learn more about spinal cord injury,” she said. “The research team and I have queried the data to learn more about this relatively uncommon kind of injury.”
By having access to outcome data on thousands of patients, she said, they can learn more about these relatively rare conditions.
“What is really unique about this overall project is that you have rehabilitation doctors and neurosurgeons working together,” said O’Connell. “We cover the continuum of what happens to people with spinal cord injuries.”
By working together and proactively following their patients, they are able to find answers that individual provinces or sites would not be able to, she said.
“The patient’s journey from injury to home is investigated. The sensitivity to factors important throughout their care (arrival, surgery, and rehabilitation) is monitored as opposed to being restricted to the interest or outcomes of a single time point or medical professional.”
The current study found that a quarter of patients left the hospital with full bowel and bladder control, and half can walk independently. The study also found other factors that had the potential to impact patient outcomes, such as time to admission, time to rehabilitation care post-injury, and rehabilitation length of stay.
Through their collaboration, the research team was able to reach their goal. The information they’ve uncovered is useful for clinicians to predict potential outcomes, enabling them to better communicate recovery expectations to patients and their families.
This story is sponsored by the New Brunswick Health Research Foundation (NBHRF).