Body mass index has an impact on preoperative symptoms but not clinical outcome in acute cauda equina syndrome

Vicki M. Butenschoen,Bernhard Meyer,Shadi Abulhala,Jens Gempt

doi:10.1038/s41598-021-92969-4

Vicki M. Butenschoen, Bernhard Meyer + Show 2 more

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https://doi.org/10.1038/s41598-021-92969-4

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Abstract

Cauda equina syndrome (CES) presents a surgical emergency with treatment required within 48 h. Symptoms include reduced saddle sensation, micturition difficulties, and/or anal sphincter impairment. Controversy exists regarding the effect on and coincidence of overweight with CES. We performed a retrospective case–control study of all patients treated surgically for acute complete and incomplete CES in our neurosurgical department from 2009 to 2020, focusing on the preoperative BMI and postoperative neurological outcome. In addition, we performed a comprehensive literature review. Fifty patients with CES were included, of whom 96% suffered from a decompensated lumbar spinal stenosis or disc prolapse between the L4/5 and L5/S1 levels. Our cohort population was overweight but not obese: mean BMI was 27.5 kg/m2, compared with 27.6 kg/m2 in patients with degenerative spine surgery. BMI did not significantly influence the postoperative outcome, but it did affect preoperative symptoms and surgery duration. Symptom duration significantly differed depending on the underlying cause for CES. The literature review revealed sparse evidence, with only four clinical case series presenting contradictory results. We provide a comprehensive literature review on the current evidence regarding CES and obesity and conclude that we did not observe an association between obesity and CES occurrence. Patients with CES and other degenerative spinal pathologies belong to an overweight but not obese population. Body Mass Index has an impact on preoperative symptoms but not clinical outcome in acute CES.

Highlights

Cauda equina syndrome (CES) presents a surgical emergency with treatment required within 48 h
Median age significantly depended on the underlying pathology
Of Cushnie et al and Venkatesan et al.: In our cohort study, CES was not associated with obesity, but patients undergoing spinal lumbar surgery seemed to belong to an overweight population, similar to our control patients undergoing spinal surgery for degenerative spinal pathologies without exhibiting symptoms of CES

Summary

Introduction

Cauda equina syndrome (CES) presents a surgical emergency with treatment required within 48 h. Patients with acute cauda equine syndrome (CES) present with sensation loss of the perineal region, urinary retention, or loss of anal sphincter control. Even though these conditions are rare, patients are significantly burdened due to the limited recovery rates and persistent impaired vegetative functions. Most patients presenting with acute symptoms of cauda equina compression suffer from extensive disc prolapses compressing the cauda equina nerve roots[1,2] or show evidence of a decompensated spinal canal obstruction[3]. Only 10 studies addressed the controversy over BMI and CES, of which 4 included retrospective (n = 3) or prospective (n = 1) clinical studies, and 6 publications were only single case reports. All studies were classified as level III and level IV studies (following the Oxford Centre for Evidence-Based Medicine [OCEBM] levels of evidence)

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