Cauda equina syndrome (CES) from lumbar disc herniations
William C Olivero1, Huan Wang, William C Hanigan
1Department of Neurosurgery, University of Illinois at Champaign-Urbana, Champaign, IL, USA. olib@uic.edu
Journal of Spinal Disorders & Techniques
|May 5, 2009
Summary
Cauda equina syndrome (CES) recovery, particularly bladder function, is not dependent on surgical timing. Most patients with CES from lumbar disc herniation regain continence regardless of delayed surgery.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Neurology
Background:
- Cauda equina syndrome (CES) from lumbar disc herniation is a recognized surgical emergency.
- Optimal surgical timing for CES remains debated, with some studies suggesting early intervention is crucial for functional recovery.
Purpose of the Study:
- To evaluate the outcomes of CES patients treated surgically for lumbar disc herniation.
- To determine the correlation between time to surgery and recovery of neurological and bladder function.
Main Methods:
- A retrospective review of 31 patients with CES due to lumbar disc herniation (1985-2004).
- Analysis of surgical timing (within 24h, 24-48h, after 48h) and functional outcomes (bladder, motor, sensory).
- Average follow-up of 5 years.
Main Results:
- Over 90% of patients regained bladder continence.
- No correlation was found between time to surgery and recovery of bladder, motor, or sensory function.
- Most patients underwent hemilaminotomy; decompressive laminectomy was reserved for specific cases.
Conclusions:
- Surgical intervention for CES due to lumbar disc herniation can lead to significant recovery of bladder function, irrespective of the delay.
- Early surgical intervention is not necessarily correlated with improved functional outcomes in CES.
- Less invasive surgical approaches like hemilaminotomy are often sufficient for treating CES.
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