Cauda Equina Syndrome: prognostic factors and surgical outcome

Tayel, Amr Mohamed; Hemdan, Ali Rabee Kamel; Elmalky, Islam; Essa, Abdelhakeem

doi:10.21608/pajn.2024.302042.1138

Cauda Equina Syndrome: prognostic factors and surgical outcome

Document Type : Original Articles

Authors

¹ South Valley University, faculty of medicine, neurosurgery department, Qena, Egypt

² Neurosurgery department, Faculty of medicine, South Valley University

³ Neurology department, Faculty of medicine, South Valley University.

⁴ Neurosurgery department, Faculty of medicine, Assiut University

10.21608/pajn.2024.302042.1138

Abstract

Background: Cauda equina syndrome (CES) is a neurosurgical emergency resulting in one or more of the following: bladder, bowel, and/or sexual dysfunction, decreased saddle area sensation, and motor and/or sensory neurological deficit in the lower limbs.

Objective: This study was done to assess the clinical outcome following surgery for CES syndrome and to detect the prognostic factors.

Patients and Methods: This study was conducted with 30 patients admitted to Qena University Hospitals. Patients over 18 years old with clinical and radiological evidence of CES were included. Patients must have urinary and/or anal dysfunction, the cause of CES is herniated lumbar disc with or without canal stenosis, and the levels affected are L3-4 or lower, either single or multiple.

Results: The mean age was 43.2 years. 21 had American Society of Anesthesiologists (ASA) grade I. The mean Visual Analogue Scale (VAS) was 2.27±2.16. Urological symptoms were evident among the studied population. Saddle area sensation was normal in 10. The British Medical Research Council (BMRC) scale was of grade 4 in most cases. L4/5 was the most affected level. The time till operation was 63.97±6.8 hours. Postoperatively, most cases had 0 VAS and BMRC grade 5. BMRC and ASA were associated with quality of life (QOL).

Conclusion: CES is a neurosurgical emergency with outcomes indicated by features such as sciatic pain, bladder function, and surgery performed within 24 hours of bladder dysfunction onset. Recovery of neurological deficits may take months to years, particularly for micturition dysfunction, emphasizing the need for longer-term follow-up.

Keywords