An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome

Abstract

Background Data regarding long-term outcomes following surgery for cauda equina syndrome (CES) is scarce. In addition, these studies rely on patient descriptions of the presence or absence of symptoms, with no gradation of severity. This study aimed to assess long-term bladder, bowel, sexual and physical function using validated questionnaires in a CES cohort. Methods A pre-existing ethically approved database was used to identify patients who had undergone surgery for CES between August 2013 and November 2014. Patients were contacted over a 1-month period between August and September 2017 and completed validated questionnaires via telephone, assessing bladder (Urinary Symptom Profile), bowel (Neurogenic Bowel Dysfunction Score), sexual dysfunction (Arizona Sexual Experiences Scale) and physical function (Physical Component Summary of SF-12 Questionnaire), with scores compared between those presenting with incomplete CES (CES-I) and CES with retention (CES-R). Patients were also asked which of their symptoms currently they would most value treatment for and what healthcare services they had accessed post-operatively. Results Forty-six of 77 patients (response rate 72%, inclusion rate 60%) with a mean age of 45 years (21–83) and mean time since admission of 43 months (range 36–60) took part in the follow-up study. The prevalence of bladder dysfunction was 76%, bowel dysfunction 13%, sexual dysfunction 39% and physical dysfunction 48%. Patients presenting with CES-R had significantly worse long-term outcomes in bladder (stream domain), bowel and sexual function in compared to those with CES-I. Pain was chosen as the symptom patients would most value treatment for by 57%, but only 7% reported post-operative pain management referral. Conclusions With a mean follow-up time of 43 months, these findings confirm the high prevalence of long-term bladder, sexual and physical dysfunction in CES patients and that a diagnosis of CES-R confers poorer outcomes. This study provides useful, objective data to guide the expectations of patients and clinicians.

Body mass index has an impact on preoperative symptoms but not clinical outcome in acute cauda equina syndrome

“…Improvement at follow-up significantly depended on the presence of a complete vs. incomplete CES (63.6% improvement in complete CES vs. 93.8% in incomplete CES, p = 0.048) but not on the underlying entity causing the CES ( p = 0.101). The rate of clinical recovery and persistence of numbness is congruent with published literature, describing better results in patients suffering from incomplete CES compared with complete CES 10 . BMI was not significantly associated with the probability of neurological recovery (mean BMI in patients with complete recovery 26.8 vs. 28.4 kg/m 2 , p = 0.577); symptom duration differed but failed to reach statistical significance (mean symptom duration in patients with complete recovery 2.6 days vs. 7.8 days in patients without complete recovery, p = 0.086).…”

Is scan‐negative cauda equina syndrome a functional neurological disorder? A pilot study

“…Studies that have measured quality of life outcomes in CES illustrate high levels of chronic pain impacting physical and social functioning albeit with low sample sizes [17]. Indeed, a recent assessment of the long‐term post‐surgical outcomes found that over a quarter of patients were unable to return to full employment with significantly poorer physical outcomes overall compared with the population average [18]. This on‐going symptomatic burden is reflected in our broad self‐report measures illustrating a chronic impairment to quality of life across all groups, giving important insight into the persistent disability experienced by a proportion of post‐surgical CES patients.…”

Long-term mental wellbeing and functioning after surgery for cauda equina syndrome

“…We used our institutional database for patients with cauda equina syndrome, which has previously been described in both Hoeritzauer et al and Hazelwood et al [6,8]. The data regarding psychiatric co-morbidity was previously reported in the Hoeritzauer et al dataset, of which this patient group is a selected subgroup [8].…”

“…We have previously reported bladder, bowel, sexual and physical function outcomes using validated questionnaires in a cohort of post-operative CES patients [6]. In this current study we examine mental health outcomes in this same cohort, which also represents a selected subgroup of the patients included in a previous study by Hoeritzauer et al [8].…”

“…In their systematic review of outcomes reported in analyses of patients following CES, Srikandarajah et al demonstrate that although bladder or physical function are commonly assessed (in 70.5% and 63.9% of papers respectively), sexual function is less so (26.2%), probably due to reluctance of health professionals to enquire despite its significant burden [3][4][5]. Even when these variables are assessed, often it is as a dichotomic function/dysfunction assessment, as opposed to assessing severity of dysfunction as a patient reported outcome (PROM) [6]. Further still, emotional functioning is rarely investigated-only assessed in 6.6% of papers studying outcomes after CES, with only 4.9% stating the assessment tool used and dysfunction defined in only 1.7% [3].…”