Cauda Equina Syndrome in Patients with Lumbar Disc Herniation: Postoperative Results of a Series of 10 Cases

Abstract

Introduction The Cauda Equina Syndrome (CES) is a rare clinical entity with potentially devastating consequences. Usually, patients complain concealed history of back pain and acute presentation of red flags, as severe back pain, sensory alteration in saddle or genital tract, and bladder, bowel, or sexual dysfunction. Early surgical decompression is mandatory to reduce neurological sequels. The objective of this study is to describe the clinical picture and postoperative results of patients with CES. Materials and Methods Data of 10 patients diagnosed with CES because of lumbar disc herniation (LDH) between 1994 and 2013 were collected. All of them were studied with magnetic resonance imaging or computed tomography and subsequently submitted to emergency decompressive surgery with a postoperative follow-up from 5 months to 3 years. Results The patients had an average age of 38 years (range: 19–58 years), on a male/female ratio of 8/2. Overall, 70% reported no medical history, while the remaining 30% were diabetic. Nine patients had presented a massive primary LDH and one patient was secondary to a posttraumatic LDH. All the patients had neurologic compromise ASIA D at hospital admission, but in the postoperative, 50% improved to ASIA E. The main sequel was sphincter dysfunction, present in the 50% of the patients. Conclusion Unlike what was previously reported, the majority of the patients presented immediate improvement in relation to radicular pain and motor recovery. The literature describes neurologic sequels in those patients with chronic low back pain and/or late consultation. Although our series is small, it gives us valuable information about this pathology.