Journal List > J Korean Soc Spine Surg > v.21(1) > 1076040

J Korean Soc Spine Surg. 2014 Mar;21(1):30-35. Korean.
Published online March 31, 2014.  https://doi.org/10.4184/jkss.2014.21.1.30
© Copyright 2014 Korean Society of Spine Surgery
Prognostic Factors of Clinical Outcome of Postoperative Cauda Equina Syndrome
Kyu Yeol Lee, M.D., Young Hoon Lim, M.D. and Sun Hyo Kim, M.D.
Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea.

Corresponding author: Kyu Yeol Lee, M.D. Department of Orthopedic Surgery, College of Medicine, Dong-A University, 1, Dongdaesin-dong 3-ga, Seo-gu, Busan 602-715, Korea. TEL: 82-51-240-2867, FAX: 82-51-243-9764, Email: gylee@dau.ac.kr
Received July 22, 2013; Revised August 12, 2013; Accepted February 03, 2014.

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

Retrospective study.

Objectives

We studied the clinical results and prognostic factors for the postoperative caudaequinasyndrome (CES). Summary of Literature Review: The CES is a rare complication, but its aftereffects are serious. And no satisfactory discussion about its accurate treatment guidelines and prognosis has been provided yet.

Materials and Methods

10 patients who were diagnosed with a postoperative CES were enrolled from June 2004 to February 2011. Patients were classified into group I with a favorable neurologic prognosis and groupII without neurologic improvement. The medical history, diagnosis, involved segmentand duration till CES was obtained, the duration was performed till second decompression and the clinical symptoms and the outcome of surgical treatment were investigated.

Results

Group I contained of 6cases and group 4 of cases.On average were 1.25(0.5-3) hours required for group I and 22(8-38) hours for group II until CES was diagnosed. The time span for the second operation was 7(3-12) hours for group I and 12.25(5-24) hours for group II. Of 6 cases showing motor losswere 4 cases classified as group II at the last follow-up. Of 10 cases with voiding difficulties belonged 4 cases to the group II. Voiding difficulty was continued as clinical symptom in 4 patients of group II after the secondary decompression.

Conclusion

The less the motor loss and voiding difficulty before the secondary decompression and the faster diagnosis and surgical decompression, the better the prognosis. In particular, as voiding difficulty showed the lowest recovery rate, it is considered to affect prognosis and satisfaction most seriously.

Keywords: Cauda equina syndrome; Operative treatment; Prognostic factor

Figures


Fig. 1
Post primary operative MRI of 70 year-old female with spinal stenosis L3-4, 4-5 c degenerative spondylolisthesis L4 on L5. Dorsally located epidural hematoma from T12 to L5 with compressed spinal cord, L4-5 level. (A) T2 weighted sagittal image demonstrates large epidural hematoma showing heterogenous signal intensity. (B) T1 weighted sagittal image demonstrate isointense or increased signal intensity. (C) T2-weighted axial image shows that cauda equine is compressed by hematoma at L4-5 level.
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Tables


Table 1
Patient data profile
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Table 2
The effect of early diagnosis and decompression on outcome in cauda equina syndrome
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Table 3
Clinical manifestations of postoperative cauda equina syndrome
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Table 4
Residual symptoms of postoperative cauda equina syndrome after 2nd surgery in group II at long-term follow up
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