Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

N S Korse,E Van Zwet,H W Elzevier,J A Pijpers,C L A Vleggeert-Lankamp

doi:10.1007/s00586-017-4943-8

Abstract

BackgroundEven though micturition, defecation, and sexual function are substantially affected in cauda equina syndrome (CES), data on outcome are scarce.MethodsMedical files of patients operated on lumbar herniated disc were screened for CES and retrospectively analyzed for baseline characteristics, outcome of micturition, defecation, and sexual function and possible predictors.ResultsSeventy-five CES patients (52% men) were included with a mean age of 44 years. L5–S1 was the most common affected level. Duration of CES complaints at presentation was, on average, 84 h (median 48 h). Prevalence of symptoms at presentation: sciatica (97%), altered sensation of the saddle area (93%), micturition dysfunction (92%), and defecation dysfunction (74%). Only 26 patients were asked about sexual dysfunction of whom 25 patients experienced dysfunction. Female gender was associated with more defecation dysfunction at presentation than male gender (OR 4.11; p = 0.039). All patients underwent decompressive surgery. Two post-operative follow-up (FU) moments took place after a mean of 75 h and 63 days. Outcomes at second FU moment: micturition dysfunction 48%, defecation dysfunction 42%, sexual dysfunction 53%, sciatica 48%, and altered sensation of the saddle area 57%. A shorter time to decompression was associated with more sciatica at FU 1 (p = 0.042) which effect had disappeared at FU 2.ConclusionThis study is unique in (1) displaying the presenting features in a large cohort of CES patients, (2) demonstrating that recovery after decompression is slow and far from complete in the majority of patients with regard to micturition, defecation, and sexual function and (3) evaluating predictors for outcome.

Highlights

Background Even though micturition, defecation, and sexual function are substantially affected in cauda equina syndrome (CES), data on outcome are scarce
Cauda equina syndrome (CES) is a neurological condition caused by compression of the cauda equina, most commonly described as a combination of sensory loss of the saddle area, motor deficit and/or loss of reflexes of the lower limbs, micturition dysfunction, defecation complaints, and/or sexual dysfunction [1, 2]
With a positive predictive value of 100% and a negative predictive value of merely 19%, abnormal anal sphincter tension at physical examination supports the presence of altered sensation of the saddle area, but in no way rules out altered sensation of the saddle area, in case it is normal

Summary

Introduction

Cauda equina syndrome (CES) is a neurological condition caused by compression of the cauda equina, most commonly described as a combination of sensory loss of the saddle area, motor deficit and/or loss of reflexes of the lower limbs, micturition dysfunction, defecation complaints, and/or sexual dysfunction [1, 2]. The value of urgent decompression was most convincingly showcased in the meta-analysis of Ahn et al, showing a better prognosis of sensory, motor, urinary, and rectal function in patients being decompressed within 48 h of presentation, compared to a group being decompressed after 48 h [12]. These results were confirmed by others [13, 14]. Defecation, and sexual function are substantially affected in cauda equina syndrome (CES), data on outcome are scarce

Methods

Results

Discussion

Conclusion