Medical Realities of Cauda Equina Syndrome Secondary to Lumbar Disc Herniation

Abstract

STUDY DESIGN: An analysis of 44 cauda equina syndrome cases. OBJECTIVES: To determine the neurologic outcome of cauda equina syndrome cases, in light of the significant medical implications of this disorder. SUMMARY OF BACKGROUND DATA: Cauda equina syndrome from lumbar disc herniation accounts for up to 1% of all disc herniations. Most of the literature supports surgery within 24 hours as a means of improving the outcome. METHODS: A retrospective chi 2 analysis was performed of 44 patients surgically treated for lumbar disc herniation who initially sought treatment for cauda equina syndrome. RESULTS: In 20 patients, diagnosis was made and surgery performed within 48 hours of the cauda equina syndrome onset, including 18 patients (90%) who underwent surgery within 24 hours. In 24 patients, surgery was performed more than 48 hours after the onset of cauda equina syndrome, with a mean delay of 9 days, including 17 patients (71%) with a mean delay of 3.7 days. Causes for delay were patient-related in 4 cases (17%) and physician-related in 20 cases (83%). According to chi 2 analysis, a greater chance of persistent bladder/sphincter problem (P = 0.008), persistent severe motor deficit (P = 0.006), persistent pain (P = 0.025), and sexual dysfunction (P = 0.006) existed with delayed surgery. CONCLUSION: The data strongly support the management of cauda equina syndrome from lumbar disc herniation as a diagnostic and surgical emergency.