Clinical classification of cauda equina syndrome for proper treatment

Abstract

Background and purposeCauda equina syndrome (CES) is a severe complication of lumbar spinal disorders; it results from compression of the nerve roots of the cauda equina. The purpose of this study was to evaluate the clinical usefulness of a classification scheme of CES based on factors including clinical symptoms, imaging signs, and electrophysiological findings.MethodsThe records of 39 patients with CES were divided into 4 groups based on clinical features as follows. Group 1 (preclinical): low back pain with only bulbocavernosus reflex and ischiocavernosus reflex abnormalities. Group 2 (early): saddle sensory disturbance and bilateral sciatica. Group 3 (middle): saddle sensory disturbance, bowel or bladder dysfunction, motor weakness of the lower extremity, and reduced sexual function. Group 4 (late): absence of saddle sensation and sexual function in addition to uncontrolled bowel function. The outcome including radiographic and electrophysiological findings was compared between groups.ResultsThe main clinical manifestations of CES included bilateral saddle sensory disturbance, and bowel, bladder, and sexual dysfunction. The clinical symptoms of patients with multiple-segment canal stenosis identified radiographically were more severe than those of patients with single-segment stenosis. BCR and ICR improved in groups 1 and 2 after surgery, but no change was noted for groups 3 and 4.InterpretationWe conclude that bilateral radiculopathy or sciatica are early stages of CES and indicate a high risk of development of advanced CES. Electrophysiological abnormalities and reduced saddle sensation are indices of early diagnosis. Patients at the preclinical and early stages have better functional recovery than patients in later stages after surgical decompression.

Massive lumbar disc herniation with complete dural sac stenosis

“…ODI was scored from 0 to 100, where lower scores indicated less severe symptoms. Neurological dysfunctions were categorized into 5 groups as previously described21 with modification as follows. 1) Normal: Neurologically intact.…”

Assessment of Cauda Equina Syndrome Progression Pattern to Improve Diagnosis

“…www.spinejournal.com April 2014 attributable to specific causes, such as trauma, lumbar puncture, and postoperative hematoma. They experienced symptoms simultaneously and rapidly progressed to sphincter dysfunction, which are the typical symptoms of CES that enable clinicians to provide a rapid diagnosis.…”

Treatment of cauda equina syndrome caused by lumbar disc herniation with percutaneous endoscopic lumbar discectomy

“…The surgical outcomes were assessed by using Macnab criteria [14]. The patients' status were classified as excellent (Macnab criteria score 9-10), good (7)(8), fair (5-6), and poor (4 or less). The visual analogue scale (VAS 0-10 points) for leg pain and back pain was used preoperatively and postoperatively.…”

“…With regard to onset of CES, Tay and Chacha classified CES as acute group, subacute group and chronic group [6]. Based on etiology, pathogenesis, clinical symptoms and signs, radiological assessments and electrophysiological findings, Shi et al divided CES into preclinical stage, early stage, middle stage and late stage (Table 1) [7]. They concluded that patients with CES at the early and middle stages had better bladder or bowel functional recovery than those at the late stage after decompression.…”