Late Urodynamic Findings After Surgery for Cauda Equina Syndrome Caused by a Prolapsed Lumbar Intervertebral Disk

Hellström, Pekka; Kortelainen, Pekka; Kontturi, M

doi:10.1016/s0022-5347(17)45621-7

Cited by 61 publications

(55 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Acute trauma as a cause of this syndrome is rare [12,25], and this paper supports lumbar disc herniation as the most common aetiological factor [2,7,13]. The most consistent presenting features in this series were bladder symptoms in association with saddle hypoaesthesia and loss of motor function.…”

Section: Discussionsupporting

confidence: 66%

Predictors of outcome in cauda equina syndrome

2000

Journal of Manipulative and Physiological Therapeutics

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 66%

Predictors of outcome in cauda equina syndrome

2000

Journal of Manipulative and Physiological Therapeutics

View full text Add to dashboard Cite

“…3,4,12,14,17,[21][22][23]30,[32][33][34][35][36][37][38][39] A recent meta-analysis 4 demonstrated improved outcomes when CES patients were treated within 48 hours, but this meta-analysis included only observational studies, thereby limiting the strength of its conclusions. 40,41 Using animal models of CES, Sayegh and colleagues 2 found no differences in neurologic outcomes with early versus delayed intervention, but better recovery times for somatosensory evoked potentials (SEP).…”

Section: Discussionmentioning

confidence: 99%

Delayed presentation of cauda equina syndrome secondary to lumbar disc herniation: functional outcomes and health-related quality of life

Busse

Bhandari

Schnittker

et al. 2001

CJEM

View full text Add to dashboard Cite

Objective: Cauda equina syndrome (CES) is a feared complication of lumbar disc herniation. It is generally accepted that CES requires decompression within 6 hours of symptom onset, but this time goal is rarely met, and the relative benefit of delayed decompression on functional status and quality of life (QOL) remains unknown. The study objective was to describe the functional status and quality of life outcomes for patients who undergo delayed surgical decompression for CES. Methods: Patients with CES who underwent decompression of a herniated lumbar disc during a 10-year period were assessed at hospital discharge and at least 4 months after the procedure. Evaluation of functional outcomes was based on a previously validated scale and QOL outcomes on the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) questionnaire. Results: During the study period, 1100 patients with herniated discs were identified, and 14 underwent surgical decompression for CES. All 14 had had symptoms for more than 38 hours before surgery. Ten patients were available for long-term follow-up. There was a strong correlation between long CES symptom duration and poor functional outcome: of 8 patients with symptoms for less than 10 days before decompression (range, 1.6-7.5 d), all had good functional outcomes. The 2 patients with more prolonged symptoms (10.6 and 14.2 d) had poor outcomes. SF-36 scores demonstrated declines in physical roles (p = 0.03), social function (p = 0.03) and increased pain (p = 0.003) compared with population norms. Correlation between SF-36 domain scores and CES symptom duration failed to achieve statistical significance, perhaps because of small sample size. Conclusions: Patients who undergo delayed decompression for CES have increased pain and impaired social and physical function. Longer delays correlate with worse functional outcomes. Beyond 24 hours, decompression delay may be associated with a poorer quality of life but, because of the rarity of CES, the sample size in this study was too small to provide definitive conclusions. Since no patients underwent surgery within 38.4 hours of symptoms, it is not possible to comment on the importance of emergent decompression in early presenters. RÉSUMÉObjectif : Le syndrome de la queue de cheval (SQC) est une complication redoutée de l'hernie discale lombaire. Il est généralement reconnu que ce syndrome nécessite une décompression dans les six heures suivant l'apparition des symptômes, mais ce délai-cible est rarement respecté et les bienfaits relatifs d'une décompression retardée du point de vue fonctionnel et de la qualité de vie demeurent inconnus. L'objectif de cette étude était de décrire le devenir de patients soumis à une EM ADVANCES • PROGRÈS DE LA MU

show abstract

“…• Urodynamic studies can show a serious disturbance of bladder function after cauda equina compression and yet the patient may have no symptoms at all [18].…”

Section: The Literaturementioning

confidence: 99%

Cauda equina syndrome: a review of the current clinical and medico-legal position

Gardner¹,

2010

View full text Add to dashboard Cite

Cauda equina syndrome (CES) is a rare condition with a disproportionately high medico-legal profile. It occurs most frequently following a large central lumbar disc herniation, prolapse or sequestration. Review of the literature indicates that around 50-70% of patients have urinary retention (CES-R) on presentation with 30-50% having an incomplete syndrome (CES-I). The latter group, especially if the history is less than a few days, usually requires emergency MRI to confirm the diagnosis followed by prompt decompression by a suitably experienced surgeon. Every effort should be made to avoid CES-I with its more favourable prognosis becoming CES-R while under medical supervision either before or after admission to hospital. The degree of urgency of early surgery in CES-R is still not in clear focus but it cannot be doubted that earliest decompression removes the mechanical and perhaps chemical factors which are the causes of progressive neurological damage. A full explanation and consent procedure prior to surgery is essential in order to reduce the likelihood of misunderstanding and litigation in the event of a persistent neurological deficit.

show abstract

Late Urodynamic Findings After Surgery for Cauda Equina Syndrome Caused by a Prolapsed Lumbar Intervertebral Disk

Cited by 61 publications

References 20 publications

Predictors of outcome in cauda equina syndrome

Predictors of outcome in cauda equina syndrome

Delayed presentation of cauda equina syndrome secondary to lumbar disc herniation: functional outcomes and health-related quality of life

Cauda equina syndrome: a review of the current clinical and medico-legal position

Contact Info

Product

Resources

About