Cauda equina syndrome: factors affecting long-term functional and sphincteric outcome

Area of Science:

• Neurosurgery
• Orthopedics
• Spinal Surgery

Background:

• Cauda equina syndrome (CES) is a severe condition resulting from lumbar disc prolapse, potentially causing lasting neurological deficits.
• The optimal timing for surgical decompression in CES remains a subject of debate.

Purpose of the Study:

• To identify factors influencing patient outcomes following surgical intervention for cauda equina syndrome (CES).

Main Methods:

• A retrospective cohort study incorporating prospective clinical follow-up was conducted.
• Fifty-six patients with sphincteric disturbances undergoing urgent surgery were assessed using historical data, physical examinations, and validated self-assessment questionnaires.

Main Results:

• Forty-two patients (78%) completed follow-up, averaging 60 months post-surgery.
• Neither acute onset nor the time to operation (within 48 hours) significantly affected outcomes.
• Leg weakness persisted in a significant number of patients (P < 0.005), and females showed higher rates of urinary incontinence (P < 0.005).
• Bowel dysfunction correlated with sexual problems post-surgery (P < 0.005).
• Patients failing post-operative catheter trials had worse outcomes.
• SF-36 scores were lower than age-matched controls, with mean ODI of 29 and Low Back Outcome Score of 42.

Conclusions:

• Symptom duration and onset speed prior to surgery did not influence outcomes beyond two years.
• Patients with a history of CES do not achieve a normal functional status, as indicated by SF-36, ODI, and Low Back Outcome Scores.