Rates of Future Lumbar Fusion in Patients with Cauda Equina Syndrome Treated With Decompression
Henry D Seidel1, Sean Pirkle, Sarah Bhattacharjee
1From the Pritzker School of Medicine (Mr. Seidel and Dr. Bhattacharjee), University of Chicago, Chicago, IL; the Department of Orthopaedics and Sports Medicine (Dr. Pirkle), University of Washington, Seattle, WA; and the Department of Orthopaedic Surgery and Rehabilitation Medicine (Dr. Baker, Dr. Lee, and Dr. El Dafrawy), University of Chicago, Chicago, IL.
Introduction:
The long-term risk of conversion to lumbar fusion is ill-defined for patients with cauda equina syndrome (CES) treated with decompression. This study aimed to identify the rates of fusion in patients with CES and compare those rates with a matched lumbar spinal stenosis (LSS) group.
Methods:
Patients with CES who underwent decompression were identified in a national database and matched to control patients with LSS. The rates of conversion to fusion were identified and compared. Multivariate logistic regression analysis identified independently associated risk factors. A subanalysis was conducted after stratifying by timing between CES diagnosis and decompression.
Results:
The rate of lumbar fusion in the CES cohort was 3.6% after 1 year, 6.7% after 3 years, and 7.8% after 5 years, significantly higher than the LSS control group at all time points (1 year: 1.6%, P = 0.001; 3 years: 3.0%, P < 0.001; 5 years: 3.8%, P < 0.001). CES was independently associated with increased risk of conversion to fusion (odds ratio: 2.13; 95% confidence interval: 1.56 to 2.97; P < 0.001). Surgical timing was not associated with risk of conversion to fusion.
Conclusions:
After 5 years, 7.8% of patients with CES underwent fusion, a markedly higher rate compared with patients with LSS. Counseling patients with CES on this increased risk of future surgery is important for patient education and satisfaction.
