Abstract
A prospective longitudinal inception cohort study of 33 patients undergoing surgery for cauda equina syndrome (CES) due to a herniated lumbar disc. To determine what factors influence spine and urinary outcome measures at 3 months and 1 year in CES specifically with regard to the timing of onset of symptoms and the timing of surgical decompression. CES consists of signs and symptoms caused by compression of lumbar and sacral nerve roots. Controversy exists regarding the relative importance of timing of surgery as a prognostic factor influencing outcome. Post-operative outcome was assessed at 3 months and 1 year using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) scores for leg and back pain and an incontinence questionnaire. Statistical analysis was used to determine the association between pre-operative variables and these post-operative outcomes with a specific emphasis on the timing of surgery. Surgery was performed on 12 (36%) patients within 48 h of the onset of symptoms including seven patients (21%) who underwent surgery within 24 h. Follow up was achieved in 27 (82%) and 25 (76%) patients at 3 and 12 months, respectively. There was no statistically significant difference in outcome between three groups of patients with respect to length of time from symptom onset to surgery- <24, 24–48 and >48 h. A significantly better outcome was found in patients who were continent of urine at presentation compared with those who were incontinent. The duration of symptoms prior to surgery does not appear to influence the outcome. This finding has significant implications for the medico-legal sequelae of this condition. The data suggests that the severity of bladder dysfunction at the time of surgery is the dominant factor in recovery of bladder function.
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References
Ahn UM, Ahn NU, Buchowski MS, Garrett ES, Sieber AN, Kostuik JP (2000) Cauda equina syndrome secondary to lumbar disc herniation. A meta-analysis of surgical outcomes. Spine 25:1515–1522
Dining TAR, Schaeffer HR (1993) Discogenic compression of the cauda equina: a surgical emergency. Aust NZ J Surg 63:927–934
Fairbank JCT, Pynsent PB (2000) The oswestry disability index. Spine 25(22):2940–2953
Gleave JRW, Macfarlane R (1990) Prognosis of recovery of bladder function following lumbar central disc prolapse. Br J Neurosurg 4:205–210
Gleave JRW, Macfarlane R (2002) Cauda equina syndrome: what is the relationship between timing of surgery and outcome? Br J Neurosurg 16(4):325–328
Hussain SA, Gullan RW, Chitnavas BP (2003) Cauda equina syndrome: outcome and implications for management. Br J Neurosurg 17(2):164–167
Jennett WB (1956) A study of 25 cases of compression of the cauda equina by prolapsed intervertebral discs. J Neurol Neurosurg Psychiatry 19:106–116
Jones DL, Moore T (1973) The types of neuropathic bladder dysfunction associated with prolapsed lumbar intervertebral discs. Br J Urol 45:39–43
Kohles SS, Kohles DA, Karp AP, Erlich VM, Polissar NL (2004) Time dependent surgical outcomes following cauda equina syndrome diagnosis: comments on a meta-analysis. Spine 29(11):1281–1287
Kostuik JB, Harrington I, Alexander D, Rand W, Evans D (1986) Cauda equina syndrome and lumbar disc herniation. J Bone Joint Surg 68A:386–391
Kostuik JP (2004) Medicolegal consequences of cauda equina syndrome: an overview. Neurosurg Focus 16(6):39–41
Markham DE (2004) Cauda equina syndrome: diagnosis, delay and litigation risk. J Orthop Med 26(3):103–105
McGrother CW, Donaldson MMK, Shaw C, Matthews RJ, Hayward TA, Dallosso HM, Jagger C, Clarke M, Castleden CM, the MRC Incontinence Study Team (2004) Storage symptoms of the bladder: prevalence, incidence and need for services in the UK. BJU Int 93:763–769
Ng LCL, Tafazal S, Longworth S, Sell P (2004) Cauda equina syndrome: an audit. Can we do better? J Orthop Med 26(2):98–101
Nielsen B, de Nully M, Schmidt K, Hansen RI (1980) A urodynamic study of cauda equina syndrome due to lumbar disc herniation. Urol Int 35:167–170
O’Laoire SA, Crockard HA, Thomas DG (1981) Prognosis for sphincter recovery after operation for operation for cauda equina compression owing to lumbar disc prolapse. Br Med J 282:1852–1854
Rosomoff HL, Johnston JD, Gallo AE, Ludmer M, Givens FT, Carney FT, Kuehn CA (1963) Cystometry in the evaluation of nerve root compression in the lumbar spine. Surg Gynecol Obstet 117:263–270
Scott PJ (1965) Bladder paralysis in cauda equina lesions from disc prolapse. J Bone Joint Surg 47B(2):224–235
Shapiro S (1993) Cauda equina syndrome secondary to lumbar disc herniation. Neurosurgery 32:743–747
Shapiro S (2000) Medical realities of cauda equina syndrome secondary to lumbar disc herniation. Spine 25:348–352
Shephard RH (1959) Diagnosis and prognosis of cauda equina syndrome produced by protrusion of lumbar disc. Br Med J 2:1434–1439
Todd NV (2005) Cauda equina syndrome: the timing of surgery probably does influence outcome. Br J Neurosurg 19(4):301–306
Acknowledgements
We would like to acknowledge the contribution by the following surgeons and the British Association of Spinal Surgeons. Mr. Allerton, Mr. Craig, Mr. Cross, Mr. Davies, Mr. Douglas, Mr. Floyd, Mr. Green, Mr. Grevitt, Mr. Kumar, Mr. Marshall, Mr. Mehdian, Mr. Newey, Mr. Pennie, Mr. Trivedi, Mr. Schranz, Mr. Scofield and Mr. Wilson-Macdonald.
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Qureshi, A., Sell, P. Cauda equina syndrome treated by surgical decompression: the influence of timing on surgical outcome. Eur Spine J 16, 2143–2151 (2007). https://doi.org/10.1007/s00586-007-0491-y
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DOI: https://doi.org/10.1007/s00586-007-0491-y