Prognosis for sphincter recovery after operation for cauda equina compression owing to lumbar disc prolapse.

O'Laoire, Seán A.; Crockard, H. A.; Thomas, D. G.

doi:10.1136/bmj.282.6279.1852

Cited by 114 publications

(76 citation statements)

References 5 publications

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“…In the last decades, especially the topic of timing of decompression and its relation to outcome has gained much attention in literature, with several small studies showing better-albeit not always significant-outcomes after the early decompression [4][5][6][7][8][9]. Other studies could not demonstrate a better outcome after early decompression [10,11].…”

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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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: 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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“…1,24 Even though sphincter paralysis appears in an incidence of 2%, it is a destructive complication of the prolapse of the lumbar intervertebral disc. 16,24 …”

Section: Epidemiology Of Cesmentioning

confidence: 99%

“…4,6,8,10,16,19,27,30,[33][34][35] CES affects the refl exes as bulbocavernosus, medioplantar and Achilles tendon. 5,9,24,25 LOW BACK PAIN More and more people begin to experience low back pain each day.…”

Section: Symptomatology Of Ces Due To Lumbar Disc Herniationmentioning

confidence: 99%

“…11,29,30 CES due to lumbar disc herniation composes 1-3% of all herniated lumbar discs. [9][10][11][12][13][14]16,17,27,36 Concerning the literature, 45% of the cases of CES are caused by lumbar disc herniation. Moreover, 2-6% of lumbar disc operations cause CES.…”

Section: Epidemiology Of Cesmentioning

confidence: 99%

“…CES due to LDH is 1-3% of all disc herniations. [8][9][10][11][12][13][14][15][16][17] There are also other causes that lead to CES such as an accident that injured the spine, complications with spinal anesthesia, drug side effects and vascular lesions of the spinal cord. 5,9,18,19 Patients usually present symptoms such as low back pain with unilateral or bilateral sciatica, reduced sensation in the saddle area, reduction of sexual function, fecal incontinence, bladder dysfunction, muscular weakness in legs and sensory loss in the perineum, buttocks and upper posterior thighs.…”

Section: Introductionmentioning

confidence: 99%

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Cauda Equina Syndrome Due to Lumbar Disc Herniation: a Review of Literature

Kapetanakis¹,

Chaniotakis²,

Kazakos³

et al. 2017

Folia Medica

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Cauda equina syndrome (CES) is a rare neurologic condition that is caused by compression of the cauda equina. Cauda equina consists of spinal nerves L2-L5, S1-S5 and the coccygeal nerve. The compression of these nerve roots can be caused mainly by lumbar disc herniation (45% of all causes). The diagnosis consists of two critical points: a) detailed history and physical examination and b) MRI or CT. The gold standard of the treatment of this syndrome is the surgical approach in combination with the timing of onset of symptoms. The surgery as an emergency situation is recommended in the fi rst 48 hours of onset of symptoms. Any delay in diagnosis and treatment leads to a poor prognosis of CES.

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