Study Design. An analysis of 44 cauda equina syndrome cases.
Objectives. To determine the neurologic outcome of cauda equina syndrome cases, in light of the significant medical implications of this disorder.
Summary of Background Data. Cauda equina syndrome from lumbar disc herniation accounts for up to 1% of all disc herniations. Most of the literature supports surgery within 24 hours as a means of improving the outcome.
Methods. A retrospective χ2 analysis was performed of 44 patients surgically treated for lumbar disc herniation who initially sought treatment for cauda equina syndrome.
Results. In 20 patients, diagnosis was made and surgery performed within 48 hours of the cauda equina syndrome onset, including 18 patients (90%) who underwent surgery within 24 hours. In 24 patients, surgery was performed more than 48 hours after the onset of cauda equina syndrome, with a mean delay of 9 days, including 17 patients (71%) with a mean delay of 3.7 days. Causes for delay were patient-related in 4 cases (17%) and physician-related in 20 cases (83%). According to χ2 analysis, a greater chance of persistent bladder/sphincter problem (P = 0.008), persistent severe motor deficit (P = 0.006), persistent pain (P = 0.025), and sexual dysfunction (P = 0.006) existed with delayed surgery.
Conclusion. The data strongly support the management of cauda equina syndrome from lumbar disc herniation as a diagnostic and surgical emergency.
Though it is well known that lumbar disc herniation can cause severe compression of the cauda equina, there have been surprisingly few articles in the literature on this syndrome. 1-15 The current author previously reported that surgery within 48 hours significantly improved the neurologic and urologic outcome. 13 Most of the patients who underwent early surgery in that report did so before 24 hours had elapsed. A published comment after that report stated: The reader should not be left with the impression that it is acceptable to wait up to 48 hours before surgery. The sooner the cauda equina is decompressed after the onset of symptoms, the more likely it is that the patient will not be left with residual neurologic deficit [p. 749].13
The overwhelming majority of modern reports concerning cauda equina syndrome also document the observation that emergent diagnosis followed by lumbar laminectomy and discectomy markedly improves neurologic and urologic outcome. 1-5,7-10 It is assumed that all physicians, and especially spine surgeons, know this and already practice this way. Patients with cauda equina syndrome who do not improve experience a profound negative impact that can lead to questions concerning the timeliness of their care. This is not an insignificant issue and needs to be addressed.
Since 1987, the current author has analyzed 44 cases of cauda equina syndrome secondary to lumbar disc herniation, reporting on the clinical outcome. Although there is some selection bias in this group of patients, the information is very important for all spine surgeons and probably all physicians in general to know.