Cauda equina syndrome due to disk herniation: Long-term functional prognosis

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Cord Injury Research

Background:

• Cauda equina syndrome (CES), often caused by lumbar disk extrusion, is typically considered a surgical emergency.
• CES is classified into incomplete (CESI) and complete (CESR) forms, with CESR characterized by urinary retention and incontinence.
• The long-term functional outcomes following surgical intervention for CES due to disk herniation require further evaluation.

Purpose of the Study:

• To assess the long-term functional outcomes of patients who underwent surgery for Cauda equina syndrome (CES) resulting from lumbar disk herniation.
• To compare the outcomes between incomplete CES (CESI) and complete CES with urinary retention (CESR) groups.
• To investigate the impact of surgical timing (early vs. late) on functional recovery in CES patients.

Main Methods:

• A retrospective observational study was conducted on CES patients who had surgery for disk herniation between 2000 and 2016.
• Data collected included demographics, time to diagnosis and surgery, preoperative neurological status, and long-term functional outcomes.
• Statistical analysis was performed to evaluate improvements in pain, sciatica, and urinary sphincter function, and to compare early versus late surgical intervention.

Main Results:

• Twenty-two patients (median age 44) were included, with 8 CESR and 14 CESI. Median time from symptom onset to diagnosis was 78 hours, and diagnosis to surgery was 24 hours.
• In the CESR group, only pain significantly improved post-surgery (p=0.007).
• In the CESI group, low back pain, sciatica, and urinary sphincter function significantly improved (p<0.001). No significant difference in sphincter recovery was observed between early (<48h) and late surgery (p=0.076).

Conclusions:

• Surgical intervention for CES due to disk herniation can lead to pain improvement in both CESI and CESR.
• Significant improvement in urinary sphincter function was observed exclusively in the CESI group.
• Long-term functional outcomes, particularly sphincter recovery, did not significantly differ between early and late surgical interventions.