title: Impact of timing on surgical outcome in patients with cauda equina syndrome caused by lumbar disc herniation.
abstract: Aim To analyze the relationship between timing of surgery and outcome in patients with cauda equina syndrome caused by lumbar disc herniation. Methods A retrospective, non-randomized clinical study included 25 consecutive patients with cauda equina syndrome (CES) caused by lumbar disc herniation. All patients were operated within 24 hours after hospitalization at the Department of Neurosurgery, Cantonal Hospital Zenica, Bosnia and Herzegovina, between January 2000 and December 2010. All patients were evaluated before surgery on the basis of complete history, neurological examination and neuroimaging evaluations using CT (computed tomography)and MRI (magnetic resonance imaging). Results Statistically significant difference between preoperative and postoperative bladder (p=0.05) and bowel (p=0.05) function was found. A significant number of patients had bladder and bowel recovery after surgery, nine (36%) and 11 (44%), respectively. Significant recovery of muscle strength was noted with complete recovery(5/5) in 12 (48%) and partial recovery in 13 (52%) patients. Complete sensory recovery was noted in 16 (64%), incomplete in four (16%), and in five (20%) patients there were no changes. Most commonly, patients with complete sensory recovery were operated within 48 hours of symptom onset. In most patients early surgery was associated with better outcome. Conclusion This research showed that early decompression correlated with better outcome. Patients with cauda equina syndrome must be cleared for surgery in optimal conditions and, if it possible within optimal timing for recovery (within 48 hours).
authors.affiliation: Department of Neurosurgery, Canton Hospital Zenica; Bosnia and Herzegovina.
authors.forename: Hakija
authors.initials: H
authors.lastname: Bečulić
authors.affiliation: Department of Neurosurgery, Canton Hospital Zenica; Bosnia and Herzegovina.
authors.forename: Rasim
authors.initials: R
authors.lastname: Skomorac
authors.affiliation: Department of Neurosurgery, Canton Hospital Zenica; Bosnia and Herzegovina.
authors.forename: Aldin
authors.initials: A
authors.lastname: Jusić
authors.affiliation: Department of Neurosurgery, Canton Hospital Zenica; Bosnia and Herzegovina.
authors.forename: Fahrudin
authors.initials: F
authors.lastname: Alić
authors.affiliation: Department of Emergency Medicine,Canton Hospital Zenica; Bosnia and Herzegovina.
authors.forename: Melica
authors.initials: M
authors.lastname: Imamović
authors.affiliation: Department of Oncology and Radiotherapy, Canton Hospital Zenica; Bosnia and Herzegovina.
authors.forename: Alma
authors.initials: A
authors.lastname: Mekić-Abazović
authors.affiliation: Department of Radiology, Canton Hospital Zenica; Bosnia and Herzegovina.
authors.forename: Alma
authors.initials: A
authors.lastname: Efendić
authors.affiliation: Neurosurgery Clinic, University Clinical Centre, Tuzla; Bosnia and Herzegovina.
authors.forename: Harun
authors.initials: H
authors.lastname: Brkić
authors.affiliation: Department of Surgery, General Hospital Tešanj; Bosnia and Herzegovina.
authors.forename: Amir
authors.initials: A
authors.lastname: Denjalić
mesh_terms: D000328:Adult; D000368:Aged; D017522:Bosnia and Herzegovina; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications*; D008159:Lumbar Vertebrae / Q000002:abnormalities*; D008875:Middle Aged; D061646:Operative Time; D011128:Polyradiculopathy / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: early decompression; recovery; sphincter dysfunction