PIECES

Cauda Equina Syndrome (CES) is a rare but serious spinal condition that is caused by compression and associated damage to the nerve roots of S2 to S5 as they sit within the spinal canal. CES is most commonly caused by an intervertebral disc herniation.
CES symptoms include bladder and bowel dysfunction/incontinence, loss of sexual function and weakness and sensory losses in the legs. These symptoms can progress rapidly, with 50% of patients progressing to permanent nerve damage in under 24 hours.
Therefore, CES symptoms need to be recognised quickly, emergency MRI scan performed, and if compression of the cauda equina is shown, emergency spinal surgery to decompress. One method of reducing the time to MRI and surgical decompression is ‘safety netting’. This involves highlighting patients who the clinician feels are at a higher risk of developing CES. The clinician then ‘safety nets’ the patients by providing information about CES symptoms, and to attend A+E immediately if they occur.
However, there is no agreed way to recognise patients at a higher risk of CES, and some clinicians feel that safety netting all back pain patients for a rare condition, such as CES, can lead to undue anxiety, fear and avoidance of activity. These behaviours are strongly linked with the development of chronic lower back pain (CLBP), which is a very common condition, with a very high health burden.
Although studies exist where CES patients post diagnosis and surgery have viewed safety netting positively, to the authors knowledge there are no studies investigating the opinions of patients without CES symptoms regarding safety netting, and whether it does cause behaviour changes linked to CLBP.
This study will examine patient’s opinions of safety netting and investigate possible behavioural changes linked to the development of CLBP.