The long term outcome of micturition, defecation and sexual function after spinal surgery for cauda equina syndrome

Abstract

BackgroundCauda equina syndrome (CES) is a rare neurologic complication of lumbar herniated disc for which emergency surgical decompression should be undertaken. Despite the common belief that the restoration of functions that are affected by CES can take several years postoperatively, follow up seldom exceeds the first year after surgery. Long term outcome of especially micturition, defecation and sexual function—which are by definition affected in CES—are unknown. The aim of this study is to evaluate 1) postoperative long term outcome of micturition, defecation and sexual function in CES patients 2) attitude of patients towards received hospital care with regard to (recovery of) these functions.MethodsCES patients were selected by screening the records of all patients operated on lumbar herniated disc in our university hospital between 1995–2010. A questionnaire was sent to the selected CES patients evaluating current complaints of micturition, defecation and sexual function and attitude towards delivered care with focus on micturition, defecation and sexual function.ResultsThirty-seven of 66 eligible CES patients were included (response rate 71%, inclusion rate 56%). Median time after surgery was 13.8 years (range 5.8–21.8 years). Dysfunction at follow up was highly prevalent: 38% micturition dysfunction, 43% defecation dysfunction and 54% sexual dysfunction. Younger age at presentation was associated with sexual dysfunction at follow up: for every year younger at presentation, odds ratio for sexual dysfunction at follow up was 1.11 (p = 0.035). Other associations with outcome were not identified. Two-third of the CES patients wished their neurosurgeon had given them more prognostic information about micturition, defecation and sexual function.ConclusionThe presented data demonstrate that dysfunction of micturition, defecation and sexual function are still highly prevalent in a large number of CES patients even years postoperatively. These alarming follow up data probably have a devastating effect on personal perceived quality of life, which should be studied in more detail. CES patients communicate a clear demand for more prognostic information. The presented figures enable clinicians to inform their CES patients more realistically about long term postoperative outcome of micturition, defecation and sexual function after surgical intervention.

Sexual and Bladder Dysfunction in Cauda Equina Syndrome: Correlation with Clinical and Urodynamic Studies

“…Only two studies have tried to find a correlation between different clinical variables and SD by systematic statistical analy-sis. Few CES outcome studies have shown rates of SD greater than 50% at a mean of 2 months, 5 years, and 14 years of follow-up [16][17][18]. A meta-analysis revealed an overall rate of 43% in 322 patients [13].…”

Cauda Equina Syndrome Core Outcome Set (CESCOS): An international patient and healthcare professional consensus for research studies

“…A prospective study of long term outcomes after surgery for 46 CES patients had a mean follow up of 43 months [27]. Validated questionnaires and unvalidated semi structured interviews were used to assess long term outcomes of bladder, bowel, sexual and physical function.…”

“…This may be a reflection that it is a rare syndrome so any attention or further research for the condition is actively engaged and welcomed by them suggesting the burden of data collection is not an issue with this patient group. A study reviewing the long-term outcomes after spinal surgery for CES showed that there was a real need for HCPs to spend sufficient time discussing the difficult issues and delivering prognostic information to patients regarding their outcomes [27]. This highlights the importance of recording and reporting the CESCOS outcomes for future research studies.…”

Der lumbale Bandscheibenvorfall – Spontanverlauf, Therapieoptionen und klinische Ergebnisse

“…Die Rezidivrate im weiteren postoperativen Verlauf wird in der Literatur mit 18 -27 % angegeben [25,26].In einer Analyse der Patienten der Kontrollgruppe aus einer großen, randomisierten, kontrollierten Studie zum Annulusverschluss wurden Faktoren gesucht, die mit einem erhöhten Risiko für ein Rezidiv eines operativ behandelten Bandscheibenvorfalls einhergehen. Dabei zeigten die Ergebnisse, dass 64 von 253 Patienten, also 25,3 %, in dieser Gruppe ein Rezidiv erlitten.…”

“…Das Kaudasyndrom hatte vor der Operation im Durchschnitt 84 Stunden bestanden [25]. In einer weiteren Studie aus dieser Arbeitsgruppe konnte darüber hinaus nachgewiesen werden, dass auch im Langzeitverlauf (im Median 13,8 Jahre nach Operation) die Symptome persistieren und eine deutliche Beeinträchtigung der Lebensqualität für die Betroffenen darstellen [26]. In einem aktuellen Review schlussfolgert der Autor, dass es eine sehr große Heterogenität in der Beschreibung des klinisch-neurologischen Ergebnisses in den Studien gibt, was die Vergleichbarkeit erheblich erschwert.…”