Prognostic Factors of Clinical Outcome of Postoperative Cauda Equina Syndrome

Kyu Yeol Lee; Young Hoon Lim; Sun Hyo Kim

doi:10.4184/jkss.2014.21.1.30

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

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Lee, Lim, and Kim: Prognostic Factors of Clinical Outcome of Postoperative Cauda Equina Syndrome

Original Article

Journal of Korean Spine Surg 2014;21(1):30-35.

Published online: 21 March 2014

DOI: https://doi.org/10.4184/jkss.2014.21.1.30

Prognostic Factors of Clinical Outcome of Postoperative Cauda Equina Syndrome

Kyu Yeol Lee, M.D., Young Hoon Lim, M.D., Sun Hyo Kim, M.D.

Department of Orthopedic Surgery, College of Medicine, Dong-A University

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

Received 22 July 2013 Revised 12 August 2013 Accepted 3 February 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 followup. 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

REFERENCES

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Figures and Tables%

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.

Table 1.

Patient data profile

Group	Case	Sex	Age (year)	Etiology	Level	Duration of symptom^* (hours)	Time to decompression^† (hours)
I	1	M	36	Stenosis	L4-S1	0.5	3
	2	M	56	Stenosis	L4-S1	3	10
	3	F	79	Stenosis	L3-S1	1.25	12
	4	M	78	HNP	L3-L4	0.5	4
	5	F	70	Stenosis	L4-S1	0.75	3
	6	F	80	HNP	L5-S1	1.5	10
II	7	M	40	Stenosis	L4-S1	8	5
	8	M	62	Stenosis	L4-S1	18	8
	9	F	66	Stenosis	L3-L5	24	12
	10	M	62	Stenosis	L3-S1	38	24

^∗ : Duration to get the diagnosis of the cauda equina syndrome after undergoing the primary operation

^† : Duration to receive the secondary decompression after diagnosis of the cauda equina syndrome

Table 2.

The effect of early diagnosis and decompression on outcome in cauda equina syndrome

Outcome	Duration from primary operation to 2^nd operation^*
Outcome	<24 hours (N)	24-62 hours (N)
Group I (n=6)	6	0
Group II (n=4)	1	3

^∗ The duration to receive the secondary decompression after undergoing the primary operation.

Table 3.

Clinical manifestations of postoperative cauda equina syndrome

	Group I (n=6)	Group II (n=4)
Lower back pain	6	4
Sciatic neuropathy	4	2
Saddle anesthesia	3	3
Motor disorder of the lower extremities (loss)	6(2)	4(4)
Sensory disorder of the lower extremities (loss)	6(3)	4(2)
Voiding difficulty	5	5
Anal sphincter tone loss	3	2

Table 4.

Residual symptoms of postoperative cauda equina syndrome after 2^nd surgery in group II at longterm follow up

	Group II (n=4)^*
Lower back pain	0
Sciatic neuropathy	0
Saddle anesthesia	1
Motor loss of the lower extremities	1
Sensory loss of the lower extremities	0
Voiding difficulty	4
Anal sphincter tone loss	1

^∗ Group I that showed the no neurological residual symptom after the secondary surgery was excluded

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