Cauda equina syndrome: factors affecting long-term functional and sphincteric outcome

Abstract

Study design: Retrospective cohort study with prospective clinical follow-up.

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

Summary of background data: 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.