Influence of timing of surgery on Cauda equina syndrome: Outcomes at a tertiary care centre in North-India
Abstract
Background: Acute cauda equina syndrome (CES) is a devastating emergency; the clinicians need to be aware of this entity for early diagnosis and prompt referral to the neurosurgical facility.
Objectives: To study the clinical profile, management and outcome of acute CES in patients referred to a tertiary care hospital.
Study Design: Prospective, Cohort Study
Material and Methods: 29 patients referred with a diagnosis of acute CES were studied prospectively. The workup of all the patients included a detailed history, clinical examination, biochemical investigations, and imaging studies. An MRI scan was done in all cases. The details of surgical management and its outcome on follow-up were noted. The outcome was divided into good and bad on the basis of presence or absence of significant motor deficit, and the need for assistance incomplete bladder emptying. Standard methods of statistical analysis were used, a p-value of <0.05 was considered statistically significant.
Results: A good outcome was observed in 16 patients (55%) while the remaining 13 patients (45%) had a poor outcome after the surgical intervention. The patients who had unilateral symptoms and those who were operated within 3 days of the onset of symptoms had a better outcome than those operated later (p <0.05). Of all the prognostic factors studied, motor deficit at presentation was observed to be significantly related to poor outcome after surgery.
Conclusion: Acute CES is a devastating clinical entity with nearly half of the patients having a poor outcome. In patients presenting with clinical involvement of a lesser magnitude, a better outcome is observed with early surgery
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References
2. Benzel EC, Hadden TA, Coleman JC Civilian gunshot wound to the spinal cord and cauda equina. Neurosurgery 1987;20:281–285
3. Cybulski GR, Stone JL, Kano R Outcome of laminectomy of civilian gunshot injuries of the terminal spinal cord and cauda equina: a review of 88 cases. Neurosurgery 1989;24:392–397
4. Kostuik JP, Harrington I, Alexander D CES and lumbar disc herniation. J Bone Joint Surg [Am] 1986; 68:386–391
5. Tay EK, Chacha PB Midline prolapse of a lumbar intervertebral disc with compression of the cauda equina. J Bone Joint Surg [Br] 1979; 61:43–46
6. Fraser S, Roberts L, Murphy E. CES: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil 2009;90 (11):1964–1968
7. Tandon PN, Sankaran B CES due to lumbar disc prolapse. Indian J Orthop (1967) ;1:112–119
8. Kostuik JP, Harrington I, Alexander D et al CES and lumbar disc herniation. J Bone Joint Surg [Am] 1986; 68:386–391
9. O’Laoire SA, Croakard HA, Thomas DG Prognosis for sphincter re-covery after operation for cauda equina compression owing to lumbar disc pro-lapse. BMJ 1981; 282:1852–1854
10. Delamater RB, Sherman JE, Carr JB CES. Neu-rological recovery following immedi-ate, early or late decompression. Spine 1991; 16:1022–1029
11. Jennett WB A study of 25 cases of compression of the cauda equina by prolapsed intervertebral discs. J Neurol Neurosurg Psychiatry 1956; 19:109
12. Luschka H. Die Halbgelenke des menschlichen Körpers. Eine Monographie. Berlin, Germany: Reimer; 1858
13. Oppenheim H, Krause F. Über einklemmung bzw: strangulation der cauda equina. Dtsch Med Wochenschr 1909; 35:697–700
14. Tait MJ, Chelvarajah R, Garvan N, Bavetta S. Spontaneous hemorrhage of a spinal ependymoma: a rare cause of acute CES. Spine 2004;29: E502-5.
15. Fraser S, Roberts L, Murphy E. CES: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil 2009;90 (11):1964–1968
16. Garfin SR, Rydevik BL, Brown RA. Compressive neuropathy of spinal nerve roots. A mechanical or biological problem? Spine 1991;16 (2):162–166
17. Shapiro S. CES secondary to lumbar disc herniation. Neurosurgery. 1993;32 (5):743-746.
24. Alastair Gibson JN, Waddell Gordon Surgical interventions for lumbar disc prolapse; updated cochrane review. Spine 2007; 32:1735–1747
25. Gleave JRW, Macfarlane R. CES: what is the relationship between timing of surgery and outcome? Br J Neurosurg 2002;16 (4):325–328
18. Ahn UM, Ahn NU, Buchowski JM, et al. Cauda Equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine2000; 25:348-352
19. Shapiro S CES secondary to disc herniation. Neurosurgery 1993; 32:743–747
20. Kohles SS, Kohles DA, Karp AP, Erlich VM, Polissar NL. Time-dependent surgical outcomes following cauda equina syndrome diagnosis: comments on a meta-analysis. Spine 2004;29 (11):1281–1287
21. Nielson B, deSully M, Schmidt K, Hansen RJ A urodynamic study of CES due to lum-bar disc herniation. Urol Int 1980; 35:167– 170
22. McCarthy MJH, Aylott CEW, Grevitt MP et al CES: factors affecting long-term functional and sphincteric outcome. Spine 2007;32 (2):207–216
23. Dinning TAR, Schaeffer HR Discogenic compression of the Cauda Equina: a surgical emergency. Aust NZ J Surg 1993; 63:927–934
24. Alastair Gibson JN, Waddell Gordon Surgical interventions for lumbar disc prolapse; updated cochrane review. Spine 2007; 32:1735–1747
25. Gleave JRW, Macfarlane R. CES: what is the relationship between timing of surgery and outcome? Br J Neurosurg 2002;16 (4):325–328
