No turning back: a long-term retrospective analysis of urgent magnetic resonance imaging (MRI) performed for suspected cauda equina compression in a tertiary referral centre

AIM: Cauda equina syndrome is a rare but potentially serious condition for which diagnosis is time-critical for the best outcomes. Magnetic resonance imaging (MRI) is the imaging modality of choice, but the diagnostic pathway is challenging as availability of 24/7 urgent MRI is mostly limited to tertiary centres. We present a 13-year experience at one such tertiary centre. MATERIALS AND METHODS: All lumbar spine MRIs performed for suspected cauda equina between 2011 and 2023 were identified retrospectively from trust-wide information technology (IT) systems. Data including time from request to scan acquisition and reporting times were analysed using automated methods with manual validation. RESULTS: At our institution, there has been a 10-fold increase in demand for MRI to exclude cauda equina compression over the last decade. In recent years, the mean duration from request to MRI acquisition was within the 4-hour national target in approximately 90% of cases, and time from MRI acquisition to first verified report met the 1-hour national target in just over half of cases (51.1% in 2023). In 2023, 90.0% of reports were verified within 4 hours and 77.5 % within 2 hours, satisfying locally defined standards. Since 2012, 377 patients with clinical suspicion of cauda equina syndrome and positive MRI proceeded to spinal surgery within a week. The mean 5.1% operative rate between 2012 and 2023 corresponds well to previous literature. CONCLUSION: There is a rising demand for urgent MRI to exclude cauda equina compression with consequent logistical and financial considerations required to meet new national guidance on scan acquisition and reporting targets.