Developing New Knowledge Relating to the Cauda Equina and the Management of Cauda Equina Syndrome in an Illustrative Form

Eaves, Ruth (2025) Developing New Knowledge Relating to the Cauda Equina and the Management of Cauda Equina Syndrome in an Illustrative Form. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Introduction: Cauda Equina Syndrome (CES) is rare and devastating, having life-changing consequences. The cauda equina (CE) provides innervation to the lower limbs, sphincter, bowel, bladder, and sensation of the buttocks and around the anus. There is no widely agreed definition of CES, and symptom presentation is variable. Greenhalgh et al (2015) researched the impact of CES on patients’ lives and showed that clinician-patient communication requires improvement. This finding informed the work presented in this thesis, whose aim was to produce accurate tools to assist clinicians in the early identification of patients at risk of CES. Methods: The author, a medical artist, was commissioned to design and illustrate four sets of materials, reported as four studies: development of a patient CES cue card; development of a clinician A4 cue card; development of a high-quality anatomical illustration of the CE; producing a diagram to assist clinicians in examining the saddle region of patients suspected of CES. Results: A patient cue card was produced and is used across the UK and has been translated to 34 languages. A clinician cue card was produced and is used by Physiotherapists and GPs and included in a textbook. A uniquely detailed illustration of the CE was produced and is used in medical teaching. An illustration was produced, detailing positioning for examination of the saddle area in suspected CES cases and is on the CSP website and published in a textbook. Discussion and Conclusion Four novel resources have been produced and circulated widely. They have been included in websites, textbooks, teaching materials, cards etc, but evidence about their impact on clinicians, students and patients is still required. This work involved a collaboration between a medical artist, physiotherapists and an anatomist. It shows potential to positively impact the lives of patients with/at risk of CES.