Cauda equina syndrome (CES) from lumbar disc herniations.
METHODS
A retrospective review was performed to determine the outcomes of patients with cauda equina syndrome (CES) from a herniated lumbar disc at our institutions.


OBJECTIVE
CES from lumbar herniated discs is considered the only absolute indication for surgery. It is considered a neurosurgical emergency with the outcome related to how quickly it is diagnosed and treated. The results of recovery of bladder function are felt by many authors to be related to early diagnosis and surgical intervention. Most authors recommend a wide decompressive laminectomy when surgery is performed. We reviewed our cases to determine if they conformed to these assumptions.


BACKGROUND
Although many articles regarding the outcome of CES from herniated lumbar discs suggest that early surgery is superior to surgery that is delayed, others have demonstrated no correlation between time-to-surgery and chances for recovery of neurologic and bladder function.


METHODS
A retrospective review of all patients with lumbar herniated discs and CES from the years 1985 to 2004 was carried out. There were 31 patients, 28 of whom had bladder incontinence or retention requiring catheterization. Six patients were operated within 24 hours, 8 between 24 and 48 hours, and 17 after 48 hours (range: 60 h to 2 wk). Average follow-up was 5 years.


RESULTS
Twenty-seven of these patients regained continence not requiring catheterization. There was no correlation between the time-to-surgery and recovery of bladder function. There was also no correlation between the time-to-surgery and recovery of motor and sensory function. The majority of patients underwent unilateral hemilaminotomy or bilateral hemilaminotomies; decompressive laminectomy was reserved for patients with underlying spinal stenosis or posteriorly herniated fragments. All of the patients were relieved of their radicular pain.


CONCLUSIONS
In our series of patients with CES and bladder incontinence or retention, over 90% regained continence. Recovery of function was not related to the time to surgical intervention. The majority of the patients were adequately treated without the need for a complete laminectomy.
Department of Neurosurgery, University of Illinois at Champaign-Urbana, Champaign, IL, USA. olib@uic.edu
William C
WC
Olivero
Huan
H
Wang
William C
WC
Hanigan
John P
JP
Henderson
Patrick T
PT
Tracy
Patrick W
PW
Elwood
J Richard
JR
Lister
Lynne
L
Lyle
D000328:Adult; D000368:Aged; D002420:Cauda Equina / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000473:pathology*; D007796:Laminectomy / Q000379:methods / Q000706:statistics & numerical data; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011128:Polyradiculopathy / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D011843:Radiculopathy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D014546:Urinary Catheterization / Q000706:statistics & numerical data; D055815:Young Adult