Skip to main content
SpringerLink
Log in

Complaints of micturition, defecation and sexual function in cauda equina syndrome due to lumbar disk herniation: a systematic review

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Cauda equina syndrome (CES) is a rare complication of lumbar disk herniation. Although micturition, defecation and/or sexual function are by definition affected, little seems to be known about long-term outcome. Aim of this study is to review current literature on outcome of micturition, defecation and sexual function in CES due to lumbar disk herniation.

Methods

A literature search was done in Pubmed, Embase and Web of Science using a sensitive search string combination. Studies were selected by predefined selection criteria and risk of bias was assessed using a Cochrane checklist adjusted for this purpose.

Results

Fifteen studies were included. Risk of bias varied with six studies showing low risk. Mean minimal follow-up time was 17.0 months (range 3–24 months). All studies evaluated micturition and reported dysfunction at follow-up in 42.5 % (range 13.3–90.0 %). Defecation and sexual function were evaluated in eight and nine studies, respectively, and reported to be 49.6 (range 10.5–90.0 %) and 44.3 % (range 10.0–76.6 %), respectively. Only two studies assessed sexual function in all patients at follow-up.

Conclusion

This review offers an insight into the extent of micturition dysfunction, defecation dysfunction and sexual dysfunction (SD) in CES after decompression. Our findings show that dysfunction is extremely common, even at long-term follow-up. A condition as invalidating as CES requires proper patient information and the outcomes presented here may help in providing those data. Bias in included studies, lack of universal definitions and incomplete follow-up results qualify these data as the best we momentarily have, but still subject to improvement. Since SD seems to be severely underreported, we recommend further research to explore the extent of this problem, as well as the use of questionnaires in future clinical (prospective) studies to accomplish a more patient-based approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Mixter WJ, Barr JS (1934) Rupture of the intervertebral disk with involvement of the spinal canal. N Engl J Med 211(5):210–225

    Article  Google Scholar 

  2. Fraser S, Roberts L, Murphy E (2009) Cauda equina syndrome: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil 90(11):1964–1968. doi:10.1016/j.apmr.2009.03.021

    Article  PubMed  Google Scholar 

  3. Shephard RH (1959) Diagnosis and prognosis of cauda equina syndrome produced by protrusion of lumbar disk. Br Med J 2(5164):1434–1439

    Article  PubMed  CAS  Google Scholar 

  4. Aho AJ, Auranen A, Pesonen K (1969) Analysis of cauda equina symptoms in patients with lumbar disk prolapse. Pre-operative and follow-up clinical and cystometric studies. Acta Chir Scand 135(5):413–420

    PubMed  CAS  Google Scholar 

  5. Jennett WB (1956) A study of 25 cases of compression of the cauda equina by prolapsed intervertebral disks. J Neurol Neurosurg Psychiatry 19(2):109–116

    Article  PubMed  CAS  Google Scholar 

  6. DeLong WB, Polissar N, Neradilek B (2008) Timing of surgery in cauda equina syndrome with urinary retention: meta-analysis of observational studies. J Neurosurg Spine 8(4):305–320. doi:10.3171/spi/2008/8/4/305

    Article  PubMed  Google Scholar 

  7. Radcliff KE, Kepler CK, Delasotta LA, Rihn JA, Harrop JS, Hilibrand AS, Albert TJ, Vaccaro AR (2011) Current management review of thoracolumbar cord syndromes. Spine J 11(9):884–892. doi:10.1016/j.spinee.2011.07.022

    Article  PubMed  Google Scholar 

  8. Spector LR, Madigan L, Rhyne A, Darden B, Kim D (2008) Cauda equina syndrome. J Am Acad Orthop Surg 16(8):471–479

    PubMed  Google Scholar 

  9. Ma B, Wu H, Jia LS, Yuan W, Shi GD, Shi JG (2009) Cauda equina syndrome: a review of clinical progress. Chin Med J 122(10):1214–1222. doi:10.3760/cma.j.issn.0366-6999.2009.10.019

    PubMed  Google Scholar 

  10. Platform-Evidence-Based-Richtlijn-Ontwikkeling (2006) Formulier III voor het beoordelen van een Cohortonderzoek. Dutch Cochrane Center. http://dcc.cochrane.org/sites/dcc.cochrane.org/files/uploads/cohort.pdf. Accessed 29 March 2012

  11. Harbord RM, Higgins JPT (2009) Meta Regression in Stata. In: Sterne JAC (ed) Meta-analysis in Stata: an updated collection from the Stata journal, 1st edn. Stata Press, College Station, pp 70–96

    Google Scholar 

  12. Higgins JPT, Thompson SG (2004) Controlling the risk of spurious findings from meta-regression. Stat Med 23:1663–1682

    Article  PubMed  Google Scholar 

  13. Shapiro S (1993) Cauda equina syndrome secondary to lumbar disk herniation. Neurosurgery 32(5):743–746 discussion 746–747

    Article  PubMed  CAS  Google Scholar 

  14. Shapiro S (2000) Medical realities of cauda equina syndrome secondary to lumbar disk herniation. Spine (Phila Pa 1976) 25(3):348–351 discussion 352

    Article  CAS  Google Scholar 

  15. Dhatt S, Tahasildar N, Tripathy SK, Bahadur R, Dhillon M (2011) Outcome of spinal decompression in cauda equina syndrome presenting late in developing countries: case series of 50 cases. Eur Spine J 20(12):2235–2239. doi:10.1007/s00586-011-1840-4

    Article  PubMed  Google Scholar 

  16. Qureshi A, Sell P (2007) Cauda equina syndrome treated by surgical decompression: the influence of timing on surgical outcome. Eur Spine J 16(12):2143–2151. doi:10.1007/s00586-007-0491-y

    Article  PubMed  Google Scholar 

  17. Kostuik JP, Harrington I, Alexander D, Rand W, Evans D (1986) Cauda equina syndrome and lumbar disk herniation. J Bone Joint Surg Am 68(3):386–391

    PubMed  CAS  Google Scholar 

  18. O’Laoire SA, Crockard HA, Thomas DG (1981) Prognosis for sphincter recovery after operation for cauda equina compression owing to lumbar disk prolapse. Br Med J (Clin Res Ed) 282(6279):1852–1854

    Article  Google Scholar 

  19. Buchner M, Schiltenwolf M (2000) Cauda equina syndrome caused by intervertebral lumbar disk prolapse—mid-term results of 22 patients and review of the literature. Neuro Orthop 27(1–2):55–64

    Google Scholar 

  20. Buchner M, Schiltenwolf M (2002) Cauda equina syndrome caused by intervertebral lumbar disk prolapse: mid-term results of 22 patients and literature review. Orthopedics 25(7):727–731

    PubMed  Google Scholar 

  21. Hussain SA, Gullan RW, Chitnavis BP (2003) Cauda equina syndrome: outcome and implications for management. Br J Neurosurg 17(2):164–167

    Article  PubMed  CAS  Google Scholar 

  22. McCarthy MJH, Aylott CEW, Grevitt MP, Hegarty J (2007) Cauda equina syndrome—factors affecting long-term functional and sphincteric outcome. Spine 32(2):207–216. doi:10.1097/01.brs.0000251750.20508.84

    Article  PubMed  Google Scholar 

  23. Crocker M, Fraser G, Boyd E, Wilson J, Chitnavis BP, Thomas NW (2008) The value of inter hospital transfer and emergency MRI for suspected cauda equina syndrome: a 2-year retrospective study. Ann R Coll Surg Engl 90(6):513–516. doi:10.1308/003588408x301154

    Article  PubMed  CAS  Google Scholar 

  24. Hellstrom P, Kortelainen P, Kontturi M (1986) Late urodynamic findings after surgery for cauda equina syndrome caused by a prolapsed lumbar intervertebral disk. J Urol 135(2):308–312

    PubMed  CAS  Google Scholar 

  25. Gleave JR, MacFarlane R (1990) Prognosis for recovery of bladder function following lumbar central disk prolapse. Br J Neurosurg 4(3):205–209

    Article  PubMed  CAS  Google Scholar 

  26. Kennedy JG, Soffe KE, McGrath A, Stephens MM, Walsh MG, McManus F (1999) Predictors of outcome in cauda equina syndrome. Eur Spine J 8(4):317–322

    Article  PubMed  CAS  Google Scholar 

  27. Spannare BJ (1978) Prolapsed lumbar intervertebral disk with partial or total occlusion of the spinal canal. A study of 30 patients with and 28 patients without cauda equina symptoms. Acta Neurochir (Wien) 42(3–4):189–198

    Article  CAS  Google Scholar 

  28. Elgamri A, Sami A, Aqqad A, Hilmani S, Ibahioin K, Naja A, El Kamar A, El Azhari A (2009) Posterior migration of a lumbar disk herniation as a cause of cauda equina syndrome. J Radiol 90(6):731–733 French

    Article  PubMed  CAS  Google Scholar 

  29. Schaeffer HR (1966) Cauda equina compression resulting from massive lumbar disk extrusion. Aust N Z J Surg 35(4):300–306

    Article  PubMed  CAS  Google Scholar 

  30. von Wild K (1990) Lumbar intervertebral disk operation in the aged. Zentralbl Neurochir 51(1):34–41

    Google Scholar 

  31. Akbas NB, Dalbayrak S, Kulcu DG, Yilmaz M, Yilmaz T, Naderi S (2010) Assessment of sexual dysfunction before and after surgery for lumbar disk herniation. J Neurosurg Spine 13(5):581–586. doi:10.3171/2010.5.spine09906

    Article  PubMed  Google Scholar 

  32. Fairburn B, Stewart JM (1955) Lumbar disk protrusion as a surgical emergency. Lancet 269(6885):319–321

    Article  PubMed  CAS  Google Scholar 

  33. Lafuente DJ, Andrew J, Joy A (1985) Sacral sparing with cauda equina compression from central lumbar intervertebral disk prolapse. J Neurol Neurosurg Psychiatry 48(6):579–581

    Article  PubMed  CAS  Google Scholar 

  34. Todd NV (2005) Cauda equina syndrome: the timing of surgery probably does influence outcome. Br J Neurosurg 19(4):301–306. doi:10.1080/02688690500305324

    Article  PubMed  CAS  Google Scholar 

  35. Tsai CH, Chou ECL, Chou LW, Chen YJ, Chang CH, Tsou HK, Chen HT (2010) The evaluation of bladder symptoms in patients with lumbar compression disorders who have undergone decompressive surgery. Spine 35(17):E849–E854

    Article  PubMed  Google Scholar 

  36. Jegede KA, Ndu A, Grauer JN (2010) Contemporary management of symptomatic lumbar disk herniations. Orthop Clin North Am 41(2):217–224

    Article  PubMed  Google Scholar 

  37. Akbar A, Mahar A (2002) Lumbar disk prolapse: management and outcome analysis of 96 surgically treated patients. J Pak Med Assoc 52(2):62–65

    PubMed  CAS  Google Scholar 

  38. Bartels R, deVries J (1996) Hemi-cauda equina syndrome from herniated lumbar disk: a neurosurgical emergency? Can J Neurol Sci 23(4):296–299

    PubMed  CAS  Google Scholar 

  39. Choudhury AR, Taylor JC (1980) Cauda equina syndrome in lumbar disk disease. Acta Orthop Scand 51(3):493–499

    PubMed  CAS  Google Scholar 

  40. Nielsen B, de Nully M, Schmidt K, Hansen RI (1980) A urodynamic study of cauda equina syndrome due to lumbar disk herniation. Urol Int 35(3):167–170

    Article  PubMed  CAS  Google Scholar 

  41. Dinning TA, Schaeffer HR (1993) Discogenic compression of the cauda equina: a surgical emergency. Aust N Z J Surg 63(12):927–934

    Article  PubMed  CAS  Google Scholar 

  42. Podnar S, Oblak C, Vodusek DB (2002) Sexual function in men with cauda equina lesions: a clinical and electromyographic study. J Neurol Neurosurg Psychiatry 73(6):715–720

    Article  PubMed  CAS  Google Scholar 

  43. Podnar S (2006) Bowel dysfunction in patients with cauda equina lesions. Eur J Neurol 13(10):1112–1117. doi:10.1111/j.1468-1331.2006.01423.x

    Article  PubMed  CAS  Google Scholar 

  44. Podnar S, Trsinar B, Vodusek DB (2006) Bladder dysfunction in patients with cauda equina lesions. Neurourol Urodyn 25(1):23–31. doi:10.1002/nau.20188

    Article  PubMed  Google Scholar 

  45. Scott PJ (1965) Bladder paralysis in cauda equina lesions from disk prolapse. J Bone Joint Surg Br 47:224–235

    PubMed  CAS  Google Scholar 

  46. Mosdal C, Iversen P, Iversen-Hansen R (1979) Bladder neuropathy in lumbar disk disease. Acta Neurochir (Wien) 46(3–4):281–286

    Article  CAS  Google Scholar 

  47. Jalloh I, Minhas P (2007) Delays in the treatment of cauda equina syndrome due to its variable clinical features in patients presenting to the emergency department. Emerg Med J 24(1):33–34. doi:10.1136/emj.2006.038182

    Article  PubMed  Google Scholar 

  48. Inui Y, Doita M, Ouchi K, Tsukuda M, Fujita N, Kurosaka M (2004) Clinical and radiologic features of lumbar spinal stenosis and disk herniation with neuropathic bladder. Spine (Phila Pa 1976) 29(8):869–873

    Article  Google Scholar 

  49. Olivero WC, Wang HA, Hanigan WC, Henderson JP, Tracy PT, Elwood PW, Lister JR, Lyle L (2009) Cauda equina syndrome (CES) from lumbar disk herniations. J Spinal Disord Tech 22(3):202–206. doi:10.1097/BSD.0b013e31817baad8

    Article  PubMed  Google Scholar 

  50. Busse JW, Bhandari M, Schnittker JB, Reddy K, Dunlop RB (2001) Delayed presentation of cauda equina syndrome secondary to lumbar disk herniation: functional outcomes and health-related quality of life. CJEM 3(4):285–291

    PubMed  CAS  Google Scholar 

  51. Geisler BP, van Dam RM, Gazelle GS, Goehler A (2009) Risk of bias in meta-analysis on erythropoietin-stimulating agents in heart failure. Heart 95(15):1278–1279. doi:10.1136/hrt.2009.172163 author reply 1279

    Article  PubMed  CAS  Google Scholar 

  52. Mangum K, Partna L, Vavrek D (2012) Spinal manipulation for the treatment of hypertension: a systematic qualitative literature review. J Manip Physiol Ther. doi:10.1016/j.jmpt.2012.01.005

    Google Scholar 

  53. Hartling L, Bond K, Vandermeer B, Seida J, Dryden DM, Rowe BH (2011) Applying the risk of bias tool in a systematic review of combination long-acting beta-agonists and inhaled corticosteroids for persistent asthma. PLoS ONE 6(2):e17242. doi:10.1371/journal.pone.0017242

    Article  PubMed  CAS  Google Scholar 

  54. Scheiber-Nogueira MC (2009) Sexual dysfunction in cauda equina syndrome. Pelvi-Perineologie 4(3):191–195. doi:10.1007/s11608-009-0249-6

    Article  Google Scholar 

  55. Choy DS (1999) Early relief of erectile dysfunction after laser decompression of herniated lumbar disk. J Clin Laser Med Surg 17(1):25–27

    PubMed  CAS  Google Scholar 

  56. Orlin JR, Klevmark B (2008) Successful disk surgery after 17 years of erectile dysfunction caused by a “silent” disk protrusion. Scand J Urol Nephrol 42(1):91–93. doi:10.1080/00365590701428467

    Article  PubMed  Google Scholar 

  57. Alexander M, Rosen RC (2008) Spinal cord injuries and orgasm: a review. J Sex Marital Ther 34(4):308–324. doi:10.1080/00926230802096341

    Article  PubMed  Google Scholar 

  58. Deforge D, Blackmer J, Garritty C et al (2006) Male erectile dysfunction following spinal cord injury: a systematic review. Spinal Cord 44(8):465–473

    Article  PubMed  CAS  Google Scholar 

  59. Larsen E, Hejgaard N (1984) Sexual dysfunction after spinal cord or cauda equina lesions. Paraplegia 22(2):66–74. doi:10.1038/sc.1984.14

    Article  PubMed  CAS  Google Scholar 

  60. Zabihi N, Mourtzinos A, Maher MG, Raz S, Rodriguez LV (2008) The effects of bilateral caudal epidural S2–4 neuromodulation on female sexual function. Int Urogynecol J Pelvic Floor Dysfunct 19(5):697–700. doi:10.1007/s00192-007-0504-8

    Article  PubMed  Google Scholar 

  61. Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP (2000) Cauda equina syndrome secondary to lumbar disk herniation —A meta-analysis of surgical outcomes. Spine 25(12):1515–1522. doi:10.1097/00007632-200006150-00010

    Article  PubMed  CAS  Google Scholar 

  62. 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. doi:10.1080/0268869021000032887

    Article  PubMed  CAS  Google Scholar 

  63. Nascone JW, Lauerman WC, Wiesel SW (1999) Cauda equina syndrome: is it a surgical emergency? University Pennsylvania Orthop J 12:73–76

    Google Scholar 

  64. Gardner A, Gardner E, Morley T (2011) Cauda equina syndrome: a review of the current clinical and medico-legal position. Eur Spine J 20(5):690–697. doi:10.1007/s00586-010-1668-3

    Article  PubMed  Google Scholar 

  65. Tandon PN, Sankaran B (1967) Cauda equina syndrome due to lumbar disk prolapse. Indian J Orthop 1:112–119

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Leiden University Medical Center (LUMC), Postzone J11-R-83, Postbus 9600, RC 2300, Leiden, The Netherlands

    N. S. Korse, W. C. H. Jacobs & C. L. A. M. Vleggeert-Lankamp

  2. Department of Urology, Leiden University Medical Center (LUMC), Leiden, The Netherlands

    H. W. Elzevier

Authors
  1. N. S. Korse
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. C. H. Jacobs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. W. Elzevier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. L. A. M. Vleggeert-Lankamp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. S. Korse.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Korse, N.S., Jacobs, W.C.H., Elzevier, H.W. et al. Complaints of micturition, defecation and sexual function in cauda equina syndrome due to lumbar disk herniation: a systematic review. Eur Spine J 22, 1019–1029 (2013). https://doi.org/10.1007/s00586-012-2601-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2601-8

Keywords

Search

Navigation