Cauda Equina Syndrome Outcome: Early V/S Late Surgery

Abstract

There is no reservation that the superlative result for Cauda Equina Syndrome (CES) requires decompression by surgery. Objective: The goal of our study was to determine the effect of surgical procedure, with relation to time, on bladder and bowel symptoms. Methods: A retrospective analysis of patients undergoing surgical decompression by CES was done. The subjects with persistent symptoms were surveyed for at least two-years. BASS criteria were applied to classify CES: painless urinary retention (CESR), incomplete (CESI) and CES suspicious (CESS). The resolution of presenting autonomic symptoms was assessed following surgery. Results: A total of 120 patients were confirmed with CES and referred for surgery. Surgical treatment included all cases of laminectomy or lumbar discectomy. 60 patients reported CESR, 24cases of CESI and 36 cases of CESS. No statistical alteration in sex, age, alcohol comorbidities score and smoking by the time of surgery was noted. All patients with CESR and CESI showed a positive response in bladder and bowel dysfunction following surgery. There was no substantial change in the recovery of autonomic dysfunction associated with the time of surgery. Conclusions: Surgical decompression is an operative method of treatment that suggestively alleviates the symptoms of CES involved autonomic system. Early decompression by surgery 24 hours after start of symptoms does not seems to improve resolving of bladder or bowel dysfunction significantly