Editorial British Association of Spine Surgeons standards of care for cauda equina syndrome Timothy Germon, BSc, MBChB, FRCS, FRCS(SN), MD a , Sashin Ahuja, MBBS, MS Orth, DNB Orth, FRCS, FRCS(Orth), MSc Orth Eng b, *, Adrian T.H. Casey, MBBS, FRCS, FRCS(SN) c , Nicholas V. Todd, MBBS, FRCS, MD d , Am Rai, BM, FRCS, FRCS(Orth) e a BASS Past President, Consultant Neurosurgeon-Derriford Hospital, Plymouth, UK b Consultant Orthopaedic Spinal Surgeon-University Hospital of Wales & University Hospital Llandough, Cardiff, UK c BASS President, Consultant Neurosurgeon-The National Hospital for Neurology & Neurosurgery, Queen Square (UCLH) & The Royal National Orthopaedic Hospital Stanmore, London, UK d Consultant Neurosurgeon-Newcastle General Hospital, Newcastle Upon Tyne, UK e BASS President Elect, Consultant Orthopaedic Spinal Surgeon-Norfolk & Norwich University Hospital, Norwich, UK Received 5 January 2015; accepted 5 January 2015 Introduction In 2012, the annual general meeting of the British Asso- ciation of Spine Surgeons (BASS) gave overwhelming sup- port to the proposition that the society should produce documents describing what it believed to be the best man- agement in aspects of spinal pathology. In particular, it was considered important that any such documents should be completely independent of any other organization. It was decided that the initial project should be to produce guide- lines for the standard of care for patients with possible cau- da equina syndrome (CES). This was chosen because of an overwhelming impression among the membership that some patients may well be suffering from this condition be- cause of delayed diagnosis and subsequent surgery. It was also considered that the evidence available to determine best practice was insufficient to refute the a priori argument that the earlier a compressed nerve root is decompressed, the more likely it is to recover function. At the same time, in the absence of better evidence, we consider a genuine consensus of members of our society to be valuable. Neurosurgical members of our society directed us to a document published in 2009 by the Society of British Neu- rological Surgeons entitled, ‘‘Standards of Care for Estab- lished and Suspected Cauda Equina Syndrome.’’ This formed the starting point for our own document which we thought needed to be more dogmatic if it was going to have any chance of helping patients. We were particu- larly keen that the document should help assist colleagues in primary and secondary care access magnetic resonance image (MRI) scanning. We were very aware that as special- ist practitioners, we have a very low threshold for investi- gating patients with back pain in association with any form of urinary disturbance. It seems paradoxical that less spe- cialist practitioners should have to be more dependent on clinical diagnosis but that they will be heavily criticized if they make a mistake. We are also aware that the strength of document we produced would lie with it being accepted by the spinal surgical fraternity. For this reason, the docu- ment was pasted on our society forum, and all further posts were responded to. We hope that we have produced a document that is in the best interests of the patients potentially affected by this devastating condition. We now need to consider how to promote our opinion and consider the implications for service provision. Our ambition is to work with colleagues in other specialties (eg emergency medicine, GP’s etc) to collect data on all patients presenting with potential CES secondary to compression. If we can collect these data on the national spinal registry, it should give us informa- tion on the positive predictive value of symptoms and signs. We are grateful to all those who have contributed to the evolution of this document. FDA device/drug status: Not applicable. Author disclosures: TG: Nothing to disclsose. SA: Others: Depuy Syn- thes (D, Fund a fellowship for the Unit), Nuvasive (E, Fund a fellowship for the unit); Personal Fees: Globus Medical (B, Consulting fee for convening a course in 2013, B, Consulting fee for teaching on a course in 2012). ATHC: Nothing do disclose. NVT: Nothing to disclose. AR: Nothing to disclose. The disclosure key can be found on the Table of Contents and at www. TheSpineJournalOnline.com. * Corresponding author. Department of Orthopaedics, Welsh Centre for Spinal Surgery & Trauma, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK. Tel.: (44) 7753610879. E-mail address: sashinahuja@gmail.com (S. Ahuja). http://dx.doi.org/10.1016/j.spinee.2015.01.006 1529-9430/Ó 2015 Elsevier Inc. All rights reserved. The Spine Journal 15 (2015) 2S–4S