Clinical Outcome Based Cauda Equina Syndrome Scoring System for Prediction of Prognosis

Jun-Young Yang; June-Kyu Lee; Ho-Sup Song; Yong-Bum Joo; Soo-Min Cha

doi:10.4184/jkss.2011.18.2.57

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Yang, Lee, Song, Joo, and Cha: Clinical Outcome Based Cauda Equina Syndrome Scoring System for Prediction of Prognosis

Original Article

Journal of Korean Spine Surg 2011;18(2):57-63.

Published online: 21 March 2011

DOI: https://doi.org/10.4184/jkss.2011.18.2.57

Clinical Outcome Based Cauda Equina Syndrome Scoring System for Prediction of Prognosis

Jun-Young Yang, M.D., June-Kyu Lee, M.D., Ho-Sup Song, M.D., Yong-Bum Joo, M.D., Soo-Min Cha, M.D.

Department of Orthopedic Surgery, Research Institute of Medical Science, Chungnam National University, School of Medicine, Daejeon, Korea

Corresponding author: Jun-Young Yang, M.D.33 Munwha-ro Jung-Gu Daejeon, Korea, Department of Orthopedic Surgery, Chungnam National University, School of Medicine TEL: 82-42-220-7351, FAX: 82-42-252-7098 E-mail: jyyang@cnu.ac.kr

Received 9 July 2010 Revised 1 May 2011 Accepted 16 May 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

This is a retrospective study

Objectives

We made a scoring system using the symptoms of cauda equina syndrome(CES) and we studied the efficacy of the scoring system.

Summary of the Literature Review

There has been no definite scoring system with clear factors that can predict the clinical results of cauda equine syndrome

Materials and Methods

Between 1998 and 2006, 21 patients who were diagnosed with CES and who were followed for more than 2 years were enrolled in this study. There were 6 cases of HIVD, 6 cases of degenerative spondylosis, 7 cases of vertebral fracture and 2 cases of metastatic spinal tumor. We made a scoring system for CES (SSCES) using 8 symptoms among the general clinical manifestations that accompany CES, which are low back pain, sciatic neuropathy, sensory and motor disorder of the lower extremities, loss of a saddle sensation, voiding difficulty, disorder of the anal sphincter tone and deep tendon reflex disorder.

Results

The last clinical outcomes were 3 excellent patients, 5 good patients, 5 fair patients and 8 poor patients. The mean preoperative SSCES was 11.7±2.8(7-16) and the mean final follow up score was 7.6±3.4(2-13). Eight cases that had a mean preoperative SSCES score of 6 or below showed good clinical results with a mean SSCES of 3.9±11(2-5) on the final follow up, and 13 cases with a mean preoperative SSCES score of 7 or above showed bad clinical results with a mean SSCES of 9.9±1.9(7-13) on the final follow up.

Conclusions

The prognosis was better on the final follow up for the patients with a lowere preoperative SSCES. So, for the treatment of CES, preoperative evaluation using the SSCES is thought to be very useful for predicting the prognosis.

Keywords: Cauda equina syndrome, Prognostic factor, Scoring system

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Figures and Tables%

Fig. 1.

Correlation between the preoperative and the last followup score according to the SSCES is like this.

Table 1.

Initial clinical symptoms and physical findings.

	Sex	Age	Diagnosis^∗	Group	Presentation and Examination^†								preop score
	Sex	Age	Diagnosis^∗	Group	LBP	RS	SD	MD	SA	UD	ST	DTR	preop score
1	M	31	HNP L3-4	A(7hrs)	2	1	1	0	1	2	0	0	7
2	F	28	HNP L4-5	B(19hrs)	1	2	1	0	1	2	1	0	8
3	M	31	HNP L5-S1	B(24hrs)	1	2	1	2	1	2	0	0	9
4	M	39	HNP L4-5	B(14hrs)	1	2	1	0	1	2	1	0	8
5	F	56	HNP L4-5	A(9hrs)	2	2	1	4	1	4	1	1	16
6	M	34	HNP L5-S1	A(8hrs)	2	2	1	0	1	2	1	0	9
7	F	45	SS L4-S1	B(24hrs)	1	1	1	2	1	4	1	1	12
8	F	70	SS L2-5	B(13hrs)	1	1	1	2	1	4	1	0	11
9	F	51	SS L4-5	A(6hrs)	1	2	0	2	1	2	1	0	9
10	M	68	SS L4-S1	B(22hrs)	2	1	1	2	1	4	1	2	14
11	F	44	SL L4-5	B(24hrs)	1	1	1	2	1	4	1	1	12
12	M	67	SL L4-S1	B(16hrs)	1	1	1	4	1	4	2	2	16
13	M	45	Fx. L1(Bursting)	A(10hrs)	1	1	1	0	1	4	1	1	10
14	M	42	Fx. L1(Bursting)	A(5hrs)	1	1	1	2	1	4	1	1	12
15	F	58	Fx. L1(Bursting)	B(16hrs)	1	2	1	2	1	4	2	2	15
16	F	63	Fx. L3(Bursting)	A(10hrs)	1	1	1	0	1	4	1	0	9
17	M	43	Fx.DL L1-2	B(15hrs)	2	1	1	2	1	4	1	2	14
18	M	53	Fx.DL L1-2	A(7hrs)	2	1	1	2	1	4	2	2	15
19	F	24	Fx. S1	B(14hrs)	1	2	1	2	1	4	1	1	13
20	M	47	Meta L2	B(23hrs)	2	1	1	2	1	4	1	1	13
21	M	72	Meta L4	A(8hrs)	1	1	1	2	1	4	2	2	14

^∗ HNP; herniation of nucleus pulposus, SS; spinal stenosis, SL; spondylolisthesis, B; bursting, DL; dislocation, Meta; metastatic tumor

^† LBP; low back pain, RS; radicular symptom, SD; lower extremity sensory dysfunction, MD; lower extremity motor dysfunction, SA; saddle anesthesia, UD; urinary discomfort, ST; sphincter tone, DTR; deep tendon reflex

Table 2.

Scoring System for Cauda Equina Syndrome (SSCES).

Presentation and Examination		Score
	Tolerable without medication	0
Low back pain	Tolerable with medication	1
	Intolerable in spite of medication	2
	None	0
Radicular symptoms	Intermittent	1
	Persistent or positive SLR test	2
	Normal	0
Lower extremity sensory	Paresthesia	1
	Loss	2
	Normal (or motor grade ≥ IV)	0
Lower extremity motor	Gait abnormality (or motor grade = III)	2
	Frequent fall (or motor grade ≤ II)	4
	None	0
Saddle anesthesia	Decreased	1
	Loss	2
	None	0
Urinary discomfort	Limited self voiding	2
	Unable self voiding	4
	Normal	0
Sphincter tone	Decreased	1
	Loss	2
	Normal	0
Deep tendon reflexes	Decreased	1
	Loss	2

^∗ Bladder dysfunction should be present at initial diagnosis. If all presents with mild symptoms, the total score is 10 and if all present with severe forms, the total score is 20. Lower extremity motor and urinary discomfort, which are strongly associated with daily living activity, were scored 0, 2, and 4 point.

Table 3.

Summary of the last clinical outcome.

	Presentation and Examination^*												Preop score	Last score
	Sex	Age	Diagnosis	F/u(yr)	LBP	RS	SD	MD	SA	UD	ST	DTR	Preop score	Last score
1	M	31	HNP L3-4	4.3	0	1	0	0	0	2	0	0	7	3
2	F	28	HNP L4-5	3	1	1	0	0	0	0	0	0	8	2
3	M	31	HNP L5-S1	4.2	1	1	0	0	0	2	0	0	9	4
4	M	39	HNP L4-5	6	1	1	0	0	1	2	0	0	8	5
5	F	56	HNP L4-5	7.2	1	1	1	2	1	4	0	0	16	10
6	M	34	HNP L5-S1	5	1	1	1	0	0	0	0	0	9	3
7	F	45	SS L4-S1	3.4	1	1	1	0	1	2	1	1	12	8
8	F	70	SS L2-5	3.8	1	1	0	2	0	4	0	0	11	8
9	F	51	SS L4-5	2.8	1	1	0	2	1	0	0	0	9	5
10	M	68	SS L4-S1	3.8	1	1	1	2	1	2	1	1	14	10
11	F	44	SL L4-5	3	1	1	0	0	1	2	0	0	12	5
12	M	67	SL L4-S1	3.7	1	1	1	2	1	4	1	1	16	12
13	M	45	Fx. L1(Bursting)	2.9	0	1	1	0	1	4	0	0	10	7
14	M	42	Fx. L1(Bursting)	3	1	1	1	2	1	2	0	0	12	8
15	F	58	Fx. L1(Bursting)	4.3	1	1	1	2	1	4	1	1	15	13
16	F	63	Fx. L3(Bursting)	4	1	1	0	0	0	2	0	0	9	4
17	M	43	Fx.DL L1-2	3	0	1	1	2	1	2	1	1	14	9
18	M	53	Fx.DL L1-2	3.1	1	1	1	2	1	4	1	1	15	12
19	F	24	Fx. Sacrum	4.5	1	1	1	2	1	2	1	1	13	10
20	M	47	Meta L2	2	1	1	1	2	1	2	1	1	13	10
21	M	72	Meta L4	3.5	1	1	1	2	1	4	1	1	14	12

^∗ LBP; low back pain, RS; radicular symptom, SD; lower extremity sensory dysfunction, MD; lower extremity motor dysfunction, SA; saddle anesthesia, UD; urinary discomfort, ST; sphincter tone, DTR; deep tendon reflex

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