Cauda Equina Syndrome

Abstract

In Brief Study Design. Retrospective cohort study with prospective clinical follow-up. Objective. To determine the factors that influence outcome after surgery for cauda equina syndrome (CES). Summary of Background Data. CES is a rare but serious consequence of lumbar disc prolapse and can have devastating long-lasting neurologic consequences. The timing of surgical decompression remains controversial. Methods. Fifty-six patients with evidence of a sphincteric disturbance who underwent urgent surgery were identified and invited to follow-up. The outcome measures comprised history and examination and several validated self-assessment questionnaires. Results. Forty-two patients (78%) attended with a mean follow-up of 60 months (range, 25–114 months). Mean age at onset was 41 years (range, 24–67 years) with 23 males and 19 females. Twenty-six patients were operated on within 48 hours of onset of sphincteric symptoms; 5 of these were within 24 hours. Acute onset of sphincteric symptoms and the time to operation did not influence the outcomes. Leg weakness at onset persisted in a significant number of patients at follow-up (P < 0.005). Urinary disturbance at presentation did not affect the outcomes. At follow-up, significantly more females had urinary incontinence (P < 0.005). Bowel dysfunction at presentation was associated with sexual problems at follow-up (P < 0.005). The 13 patients who failed their post operative trial without catheter had worse outcomes. The SF-36 scores at follow-up were reduced compared with age-matched controls in the population. The mean ODI was 29, Low Back Outcome Score 42, and VAS 4.5. The time elapsed from operation to follow-up was not found to influence the outcomes. Conclusions. In our series, the symptom duration before operation and the speed of onset do not affect the outcome more than 2 years after surgery. Based on the SF-36, ODI, and Low Back Outcome Scores, patients who have had CES do not return to a normal status. The outcomes of a cohort of 42 patients who have had surgery for cauda equina syndrome are presented. Symptom duration before operation does not influence the outcome 2 years after surgery. Based on the Short Form 36 Health Survey Questionnaire, Low Back Outcome Score, and Oswestry Disability Index scores, patients who have had cauda equina syndrome do not return to a normal status.