Cauda equina syndrome: factors affecting long-term functional and sphincteric outcome.
METHODS
Retrospective cohort study with prospective clinical follow-up.


OBJECTIVE
To determine the factors that influence outcome after surgery for cauda equina syndrome (CES).


BACKGROUND
CES is a rare but serious consequence of lumbar disc prolapse and can have devastating long-lasting neurologic consequences. The timing of surgical decompression remains controversial.


METHODS
Fifty-six patients with evidence of a sphincteric disturbance who underwent urgent surgery were identified and invited to follow-up. The outcome measures comprised history and examination and several validated self-assessment questionnaires.


RESULTS
Forty-two patients (78%) attended with a mean follow-up of 60 months (range, 25-114 months). Mean age at onset was 41 years (range, 24-67 years) with 23 males and 19 females. Twenty-six patients were operated on within 48 hours of onset of sphincteric symptoms; 5 of these were within 24 hours. Acute onset of sphincteric symptoms and the time to operation did not influence the outcomes. Leg weakness at onset persisted in a significant number of patients at follow-up (P < 0.005). Urinary disturbance at presentation did not affect the outcomes. At follow-up, significantly more females had urinary incontinence (P < 0.005). Bowel dysfunction at presentation was associated with sexual problems at follow-up (P < 0.005). The 13 patients who failed their post operative trial without catheter had worse outcomes. The SF-36 scores at follow-up were reduced compared with age-matched controls in the population. The mean ODI was 29, Low Back Outcome Score 42, and VAS 4.5. The time elapsed from operation to follow-up was not found to influence the outcomes.


CONCLUSIONS
In our series, the symptom duration before operation and the speed of onset do not affect the outcome more than 2 years after surgery. Based on the SF-36, ODI, and Low Back Outcome Scores, patients who have had CES do not return to a normal status.
McCarthy
Michael J H
MJ
Department of Spinal Studies and Surgery, Queens Medical Centre, Nottingham, United Kingdom.
Aylott
Caspar E W
CE
Grevitt
Michael P
MP
Hegarty
James
J
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000503:physiopathology*; D015331:Cohort Studies; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications; D007410:Intestinal Diseases / Q000209:etiology; D007866:Leg; D017116:Low Back Pain / Q000150:complications; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D019637:Orthopedic Procedures / Q000009:adverse effects; D011128:Polyradiculopathy / Q000150:complications / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies; D012447:Sacrum; D012585:Sciatica / Q000150:complications; D012678:Sensation Disorders / Q000209:etiology; D012725:Sexual Behavior; D013997:Time Factors; D014555:Urination Disorders / Q000209:etiology