Cauda equina syndrome secondary to lumbar disc herniation

Abstract

The authors conducted a retrospective study of 8 cases of cauda equina syndrome (CES) due to a herniated lumbar intervertebral disc, in order to highlight the clinical presentation and outcome after urgent surgical decompression. Between 1995 and 1999, 8 patients (4 men and 4 women) with ages ranging from 43 to 64 years (mean 53 years) presented with CES. There were two modes of presentation: acute to subacute (4 patients) and insidious (4 patients). In 3 patients the precipitating factor was stooping, with or without heavy lifting. One patient gave a history of stooping and heavy lifting, followed by manipulation therapy. Urinary bladder involvement was present in all patients (100%). Perianal sensory involvement was present in four cases, bilateral in two and unilateral in the other two. Seven patients had complete recovery of bladder function. One patient had residual urinary symptoms, though she was continent; she had been operated upon within 33 hours, within the classical 48 hours suggested by larger series. Residual weakness of lower limb muscles was present in three cases. In this small series there was no distinct correlation between timing of operation and results. Conclusion : The classical presentation of CES is not obvious. Surgery as an emergency is recommended: within 48 hours, according to the old rule. Even if surgery is done late due to delayed presentation, significant improvement in the bladder function can still be expected.