Cauda equina syndrome secondary to lumbar disc herniation

Uri Michael Ahn, Nicholas U. Ahn, Jacob M. Buchowski, Elizabeth S. Garrett, Ann N. Sieber, John P. Kostuik

Research output: Contribution to journalArticle

Abstract

Study Design. A meta-analysis of surgical outcomes of cauda equina syndrome secondary to lumbar disc herniation. Objectives. To determine the relationship between time to decompression after onset of cauda equina syndrome and clinical outcome, and to identify preoperative variables that were associated with outcomes. Summary of Background Data. The timing of surgical decompression for cauda equina syndrome is controversial. Although most surgeons recommend emergent decompression, results in certain studies show that delayed surgery may provide a satisfactory outcome. Methods. A meta-analysis was performed to determine the correlation between timing of decompression and clinical outcome. One hundred four citations were reviewed, and 42 met the inclusion criteria. Preoperative and postoperative data were recorded. Length of time to surgery was broken down into five groups: less than 24 hours, 24-48 hours, 2-10 days, 11 days to 1 month, and more than 1 month. Logistic regression was used to determine the association between preoperative variables and postoperative outcomes. Results. Outcomes were analyzed in 322 patients. Preoperative chronic back pain was associated with poorer outcomes in urinary and rectal function, and preoperative rectal dysfunction was associated with worsened outcome in urinary continence. In addition, increasing age was associated with poorer postoperative sexual function. No significant improvement in surgical outcome was identified with intervention less than 24 hours from the onset of cauda equina syndrome compared with patients treated within 24-48 hours. Similarly, no difference in outcome occurred in patients treated more than 48 hours after the onset of symptoms. Significant differences, however, were found in resolution of sensory and motor deficits as well as urinary and rectal function in patients treated within 48 hours compared with those treated more than 48 hours after onset of symptoms. Conclusions. There was a significant advantage to treating patients within 48 hours versus more than 48 hours after the onset of cauda equina syndrome. A significant improvement in sensory and motor deficits as well as urinary and rectal function occurred in patients who underwent decompression within 48 hours versus after 48 hours.

Original languageEnglish (US)
Pages (from-to)1515-1522
Number of pages8
JournalSpine
Volume25
Issue number12
DOIs
StatePublished - Jun 15 2000

Keywords

  • Cauda equina syndrome
  • Lumbar disc herniation
  • Surgical outcome

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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  • Cite this

    Ahn, U. M., Ahn, N. U., Buchowski, J. M., Garrett, E. S., Sieber, A. N., & Kostuik, J. P. (2000). Cauda equina syndrome secondary to lumbar disc herniation. Spine, 25(12), 1515-1522. https://doi.org/10.1097/00007632-200006150-00010