Cauda Equina Syndrome (CES) From Lumbar Disc Herniations

Olivero, William C.; Wang, Huan; Henderson, John P.; Tracy, Patrick T.; Elwood, Patrick W.; Lister, J.; Lyle, Lynne

doi:10.1097/bsd.0b013e31817baad8

Cited by 61 publications

(38 citation statements)

References 19 publications

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“…Some studies with smaller patient numbers display a significant better outcome after earlier decompression as well, with significant better outcomes with decompression within 48 h [9] and even after 10 days [4]. Studies displaying no difference in outcome are a minority and evaluate relative small patient numbers only [10,11]. The finding in this study that a shorter time to decompression is associated with more sciatica at FU 1, should, therefore, be weighed by the small patient number of this study and the fact that this finding is not present at FU 2 anymore.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies could not demonstrate a better outcome after early decompression [10,11]. The value of urgent decompression was most convincingly showcased in the meta-analysis of Ahn et al, showing a better prognosis of sensory, motor, urinary, and rectal function in patients being decompressed within 48 h of presentation, compared to a group being decompressed after 48 h [12].…”

Section: Introductionmentioning

confidence: 99%

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Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

et al. 2017

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Background Even though micturition, defecation, and sexual function are substantially affected in cauda equina syndrome (CES), data on outcome are scarce. Methods Medical files of patients operated on lumbar herniated disc were screened for CES and retrospectively analyzed for baseline characteristics, outcome of micturition, defecation, and sexual function and possible predictors. Results Seventy-five CES patients (52% men) were included with a mean age of 44 years. L5-S1 was the most common affected level. Duration of CES complaints at presentation was, on average, 84 h (median 48 h). Prevalence of symptoms at presentation: sciatica (97%), altered sensation of the saddle area (93%), micturition dysfunction (92%), and defecation dysfunction (74%). Only 26 patients were asked about sexual dysfunction of whom 25 patients experienced dysfunction. Female gender was associated with more defecation dysfunction at presentation than male gender (OR 4.11; p = 0.039). All patients underwent decompressive surgery. Two post-operative follow-up (FU) moments took place after a mean of 75 h and 63 days.Outcomes at second FU moment: micturition dysfunction 48%, defecation dysfunction 42%, sexual dysfunction 53%, sciatica 48%, and altered sensation of the saddle area 57%. A shorter time to decompression was associated with more sciatica at FU 1 (p = 0.042) which effect had disappeared at FU 2. Conclusion This study is unique in (1) displaying the presenting features in a large cohort of CES patients, (2) demonstrating that recovery after decompression is slow and far from complete in the majority of patients with regard to micturition, defecation, and sexual function and (3) evaluating predictors for outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

et al. 2017

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“…2 Up to 90% of patients who receive timely treatment may regain lost bladder function at five years. 1 Magnetic resonance imaging should be ordered immediately on consideration of the diagnosis, since it is the standard for imaging soft tissue of the spine. Computed tomography is much less accurate and should be done only if immediately available and MRI is not, and only if it would not delay access to MRI.…”

Section: Urinary Incontinence From Cauda Equina Syndrome May Be Revermentioning

confidence: 99%

“…Although most presentations (70%) are acute, a more gradual onset can also occur 3 Most patients (70%) will present with severe back and leg pain rather than numbness and incontinence. 1 The syndrome often evolves subacutely over days and sometimes weeks. Up to 30% of patients may present without back pain…”

mentioning

confidence: 99%