Analysis of clinical and neurological outcomes in patients with cauda equina syndrome caused by acute lumbar disc herniation: a retrospective-prospective study.

Si-Dong Yang,Wen-Yuan Ding,Feng Zhang

doi:10.18632/oncotarget.20453

Si-Dong Yang, Wen-Yuan Ding + Show 1 more

Open Access

https://doi.org/10.18632/oncotarget.20453

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Journal: Oncotarget	Publication Date: Aug 24, 2017
Citations: 6	License type: cc-by

Affiliation: Third Hospital of Hebei Medical University

Abstract

ObjectivesIn this research we analyzed the results of surgical treatment of cauda equina syndrome (CES) caused by acute lumbar disc herniation. We emphasize the early treatment for good neurological recovery.MethodsA retrospective-prospective, non randomized, clinical study was performed between Jan 2010 and Dec 2014. We retrospectively collected medical records of 18 patients who suffered from CES due to acute lumbar disc herniation and followed up them regularly. Visual analogue scale (VAS) score, lumbar JOA score (29 points), RR (recovery rate) and Oswestry disability index (ODI) questionnaire were used to evaluate clinical outcomes.ResultsAll patients were followed up for at least two years. Lumbar disc herniation is located at L2-3 level in 2 cases, L3-4 level in 2 cases, L4-5 level in 9 cases, L5-S1 level in 5 cases. VAS score is 6±2.5 preoperatively and 1.5±1.0 postoperatively at last follow-up (P<0.001). JOA score is 5±3.5 preoperatively, while it is 20±7 postoperatively at last follow-up (P<0.001). RR ≥ 50% was found in 12 cases. ODI is 75%±25% preoperatively, while it becomes 28%±16% postoperatively at last follow-up (P<0.001). It also shows that advanced age (≥45 years) may act as a risk factor for poor RR(<50%), while early operation (duration before surgery, <48 h) proves to be a protective factor.ConclusionsEarly operations are mandatory and closely relevant to final outcomes for CES patients. However, elder patients are more likely to have poor clinical effect after surgery.

Highlights

Cauda equina syndrome (CES) is a syndrome of symptoms and signs not all of which need to be present to make diagnosis; there is no agreed definition of CES [1]
Lumbar disc herniation is located at L2-3 level in 2 cases, L3-4 level in 2 cases, L4-5 level in 9 cases, L5-S1 level in 5 cases
Oswestry disability index (ODI) is 75%±25% preoperatively, while it becomes 28%±16% postoperatively at last follow-up (P

Summary

Introduction

Cauda equina syndrome (CES) is a syndrome of symptoms and signs not all of which need to be present to make diagnosis; there is no agreed definition of CES [1]. As regards to CES, there are five characteristic features including bilateral neurogenic sciatica, reduced perineal sensation, altered bladder function to painless urinary retention, loss of anal tone and sexual dysfunction [2]. In complete CES, there is complete urinary retention and severe bowel dysfunction. In incomplete CES, there is reduced urinary sensation and partial loss of bowel function. The incomplete CES patient has objective evidence of CES but retains voluntary control of micturition there www.impactjournals.com/oncotarget may be other disturbances of micturition such as urgency, poor stream, hesitancy and/or reduced bladder or urethral sensation [4]. The symptoms of CES vary differently depending on the location of the injury in cauda equina. The most essential reason is the compression of spinal nerve roots [5]

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