Medical realities of cauda equina syndrome secondary to lumbar disc herniation

Research output: Contribution to journalArticle

138 Citations (Scopus)

Abstract

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 the of the literature supports surgery within 24 hours as a means of imposing 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.

Original languageEnglish
Pages (from-to)348-352
Number of pages5
JournalSpine
Volume25
Issue number3
DOIs
StatePublished - Feb 1 2000

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Polyradiculopathy
Nervous System
Urinary Bladder
Emergencies
Physicians
Pain

Keywords

  • Cauda equina syndrome
  • Lumbar disc herniation
  • Lumbar laminectomy

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Medical realities of cauda equina syndrome secondary to lumbar disc herniation. / Shapiro, Scott.

In: Spine, Vol. 25, No. 3, 01.02.2000, p. 348-352.

Research output: Contribution to journalArticle

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abstract = "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 the of the literature supports surgery within 24 hours as a means of imposing 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.",
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