Outcomes of cauda equina syndrome due to lumbar disc herniation after surgical management and the factors affecting it: a systematic review and meta-analysis of 22 studies with 852 cases

Abstract

Purpose This study aimed to investigate the long-term clinical outcomes after surgical decompression in cauda equina syndrome (CES) and see if any preoperative patient-related factors contributed to this outcome. Methods A systematic literature search was conducted in the electronic databases of PubMed, Embase, Scopus, and Ovid. Data regarding outcome parameters from eligible studies were extracted. Meta-analysis was performed using a randomeffect model. Results A total of 852 patients (492 males and 360 females), with a mean age of 44.6 ± 5.5 years from 22 studies diagnosed with cauda equina syndrome and undergoing surgical decompression, were included in the meta-analysis; however, not all studies reported every outcome. The mean follow-up period was 39.2 months, with a minimum follow-up of 12 months in all included studies. Meta-analysis showed that on long-term follow-up, 43.3% [29.1, 57.5] (n=708) of patients had persistent bladder dysfunction. Persistent bowel dysfunction was observed in 31.1% [14.7, 47.6] (n=439) cases, sensory deficit in 53.3% [37.1, 69.6] (n=519), motor weakness in 38.4% [22.4, 54.4] (n=490), and sexual dysfunction in 40.1% [28.0, 52.1] (n=411). Decompression within 48 hours of the onset of symptoms was associated with a favourable outcome in terms of bladder function with 24.6% [1.6, 50.9] (n=75) patients having persistent dysfunction, whereas 50.3% [10.3, 90.4] (n=185) of patients in studies with a mean time to decompression after 48 hours had persistent bladder dysfunction. Other factors such as speed of onset and sex of the patients were not found to significantly impact long-term bladder outcomes. ConclusionThe long-term outcomes of CES after decompression are enumerated. Decompression within 48 hours of the onset of symptoms appears to result in fewer patients with persistent bladder dysfunction. However, a randomized controlled trial is required to conclusively determine whether early decompression leads to better outcomes.

Recovery with posterior decompression and dural suturing in a patient with cauda equina syndrome caused by lamina entrapment in an unstable burst fracture: A case report

“…Studies have consistently demonstrated that the duration of nerve compression is inversely related to the recovery of motor, sensory, and autonomic functions. In this case, surgical intervention was within the window period typically advocated for optimal outcomes, generally within 48 h of symptom onset [ 19 ]. The early release of cauda equina compression likely contributed to the progressive recovery of her neurological function, as evidenced by the return of independent ambulation and improvement in bladder and bowel control over two years.…”

The Reoperation, Readmission, and Complication Rates at 30 Days Following Lumbar Decompression for Cauda Equina Syndrome

“…Since no difference has been shown in outcomes between operating in the first 24 hours versus between 24 and 48 hours, it may be reasonable to briefly delay surgery for CES patients under specific circumstances where preoperative factors can be feasibly optimized [ 10 , 26 , 27 ]. Additionally, operating outside normal operating room hours (e.g., during nighttime) has been shown to be an independent risk factor for complications in spine surgery performed for CES [ 28 , 29 , 30 ]. Preoperative optimization may help equilibrate outcomes after lumbar decompression performed in the setting of CES closer to those of lumbar decompression performed electively.…”

Treatment of L5‐S1 Floating Calcified Lumbar Disc Herniation with Percutaneous Endoscopic Interlaminar Discectomy

“…Calcified lumbar disc herniation (CLDH) 1 is a complex type of disc herniation that is complicated by disc calcification or osteophyte formation on the basis of lumbar disc herniation. Because calcified tissue often adheres to nerve roots or the dura mater, the difficulty of surgery increases and can easily lead to complications such as nerve damage, dural damage, and cerebrospinal fluid leakage.…”