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Factors affecting urinary outcome after delayed decompression in complete cauda equina syndrome: “A regression model study”

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the recovery of urinary functions and the factors predicting urinary recovery, following delayed decompression in complete cauda equina syndrome (CESR) secondary to Lumbar disc herniation (LDH).

Methods

Retrospective study evaluated 19 cases of CESR due to single-level LDH, all presenting beyond 72 h. Mean delay in decompression was 11.16 ± 7.59 days and follow-up of 31.71 ± 13.90 months. Urinary outcomes were analysed on two scales, a 4-tier ordinal and a dichotomous scale. Logistic regression analysis was used for various predictors including delay in decompression, age, sex, radiation, level of LDH, motor deficits, type and severity of presentation. Time taken to full recovery was correlated with a delay in decompression. using Spearman-correlation.

Results

Optimal recovery was seen in 73.7% patients and time to full recovery was moderately correlated with a delay in decompression (r = 0.580, p = 0.030). For those with optimal bladder recovery, mean recovery time was 7.43 ± 5.33 months. Time to decompression and other evaluated factors were not found contributory to urinary outcomes on either scales. Three (15.8%) patients had excellent, 11 (57.9%) had good, while 3 (15.8%) and 2 (10.5%) had fair and poor outcomes respectively.

Conclusions

Occurrence of CESR is not a point of no-return and complete recovery of urinary functions occur even after delayed decompression. Longer delay leads to slower recovery but it is not associated with the extent of recovery. Since time to decompression is positively correlated with time to full recovery, early surgery is still advised in the next available optimal operative setting.

Level of evidence

IV.

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Data availability

The datasets generated during and/analysed during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was received for the study.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh, India

    Vivek Jha

  2. Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhan, India

    Gagan Deep, Kaustubh Ahuja, Syed Ifthekar & Pankaj Kandwal

  3. Department of Orthopaedics, Primus Superspeciality Hospital, New Delhi, India

    Naveen Pandita

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  1. Vivek Jha
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Contributions

All authors made substantial contributions in the study, approve the version to be published and agree to be accountable for all aspects of work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The Manuscript submitted does not contain information about medical device(s)/drug(s). No copy righted material has been used in the manuscript. The authors grant permission to reproduce copyrighted materials or signed patient consent forms.

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Correspondence to Pankaj Kandwal.

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The authors declare that they have no conflict of interest.

Ethics approval

Approval by the Institutional Ethical Committee was obtained. All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Institutional Ethical Committee of AIIMS Rishikesh. Approval letter no: AIIMS/IEC/20/91, dated 08.02.2020.

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Informed consent was obtained from all individual participants included in the study.

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Cite this article

Jha, V., Deep, G., Pandita, N. et al. Factors affecting urinary outcome after delayed decompression in complete cauda equina syndrome: “A regression model study”. Eur J Trauma Emerg Surg 48, 1009–1016 (2022). https://doi.org/10.1007/s00068-020-01589-6

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