Cauda Equina Syndrome

McCarthy, Michael; Aylott, C.; Grevitt, Michael; Hegarty, James

doi:10.1097/01.brs.0000251750.20508.84

Cited by 131 publications

(39 citation statements)

References 49 publications

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“…The study of McCarthy et al evaluated outcome of both micturition, defecation and sexual function in a cohort of 42 CES patients with a shorter follow up time than the current study (mean 5 years, minimum 2.1 years), demonstrating similar rates of dysfunction of micturition (36%), but slightly higher rates of dysfunction of defecation (60%) and sexual function (57%). [28] The higher rates of defecation and sexual dysfunction in the cohort of McCarthy et al compared to that of the presented cohort, might suggest that improvement is still possible several years post-surgery.…”

Section: Discussionmentioning

confidence: 76%

“…[28] With regard to the first finding: in our regression analysis, no differentiation was made between urinary incontinence and other micturition problems at follow up. Evaluating the outcome for micturition in our study closer, displays that the 6 patients with urinary incontinence at long term follow up, were all female; of the remaining 8 patients with micturition problems but without incontinence, 3 were female and 5 were male.…”

Section: Discussionmentioning

confidence: 99%

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The long term outcome of micturition, defecation and sexual function after spinal surgery for cauda equina syndrome

et al. 2017

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BackgroundCauda equina syndrome (CES) is a rare neurologic complication of lumbar herniated disc for which emergency surgical decompression should be undertaken. Despite the common belief that the restoration of functions that are affected by CES can take several years postoperatively, follow up seldom exceeds the first year after surgery. Long term outcome of especially micturition, defecation and sexual function—which are by definition affected in CES—are unknown. The aim of this study is to evaluate 1) postoperative long term outcome of micturition, defecation and sexual function in CES patients 2) attitude of patients towards received hospital care with regard to (recovery of) these functions.MethodsCES patients were selected by screening the records of all patients operated on lumbar herniated disc in our university hospital between 1995–2010. A questionnaire was sent to the selected CES patients evaluating current complaints of micturition, defecation and sexual function and attitude towards delivered care with focus on micturition, defecation and sexual function.ResultsThirty-seven of 66 eligible CES patients were included (response rate 71%, inclusion rate 56%). Median time after surgery was 13.8 years (range 5.8–21.8 years). Dysfunction at follow up was highly prevalent: 38% micturition dysfunction, 43% defecation dysfunction and 54% sexual dysfunction. Younger age at presentation was associated with sexual dysfunction at follow up: for every year younger at presentation, odds ratio for sexual dysfunction at follow up was 1.11 (p = 0.035). Other associations with outcome were not identified. Two-third of the CES patients wished their neurosurgeon had given them more prognostic information about micturition, defecation and sexual function.ConclusionThe presented data demonstrate that dysfunction of micturition, defecation and sexual function are still highly prevalent in a large number of CES patients even years postoperatively. These alarming follow up data probably have a devastating effect on personal perceived quality of life, which should be studied in more detail. CES patients communicate a clear demand for more prognostic information. The presented figures enable clinicians to inform their CES patients more realistically about long term postoperative outcome of micturition, defecation and sexual function after surgical intervention.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

The long term outcome of micturition, defecation and sexual function after spinal surgery for cauda equina syndrome

et al. 2017

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“…2). Selection procedure and subsequent citation tracking resulted in 16 reports on 15 different studies that met all criteria [5,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. One study was reported in two publications [19,20].…”

Section: Characteristics Of Included Studies and Risk Of Biasmentioning

confidence: 99%

“…Except for three patients who were treated conservatively [5,17,24], all patients underwent surgery. Four authors did not give exact information about type of surgery [5,[22][23][24]. Outcome was descriptive in eight studies [13,14,16,17,21,22,26,27], graded in six studies [5,15,18,20,23,25] and both urodynamic and descriptive in one study [24].…”

Section: Characteristics Of Included Studies and Risk Of Biasmentioning

confidence: 99%

Complaints of micturition, defecation and sexual function in cauda equina syndrome due to lumbar disk herniation: a systematic review

et al. 2012

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This review offers an insight into the extent of micturition dysfunction, defecation dysfunction and sexual dysfunction (SD) in CES after decompression. Our findings show that dysfunction is extremely common, even at long-term follow-up. A condition as invalidating as CES requires proper patient information and the outcomes presented here may help in providing those data. Bias in included studies, lack of universal definitions and incomplete follow-up results qualify these data as the best we momentarily have, but still subject to improvement. Since SD seems to be severely underreported, we recommend further research to explore the extent of this problem, as well as the use of questionnaires in future clinical (prospective) studies to accomplish a more patient-based approach.

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“…Urgent surgical decompression, 17 , 18 even though the exact time limit for the surgery is debated by different authors, 12 , 14 continues to be the most effective treatment. This is the only safe way of preventing the progression of the lesion and its permanent deficits 19 …”

Section: Discussionmentioning

confidence: 99%

Estudo epidemiológico da síndrome da cauda equina

et al. 2013

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OBJECTIVE: The primary purpose of this study was to determine the characteristics and outcomes of the patients admitted at our clinics diagnosed with cauda equina syndrome (CES). Secondarily, this study will serve as a basis for other comparative studies aiming at a better understanding of this condition and its epidemiology. METHODS: We conducted a retrospective study by reviewing the medical records of patients diagnosed with CES and neurogenic bladder between 2005 and 2011. The following variables were analyzed: gender, age, etiology, topographic level of the lesion, time between disease onset and diagnosis, presence of neurogenic bladder, time between diagnosis and surgery, neurological damage and neurogenic bladder persistence. RESULTS: Considering that CES is a rare condition, we were not able to establish statistic correlation between the analyzed variables and the outcomes of the disease. However, this study brought to light the inadequacy of our public health system in treating that kind of patient. CONCLUSION: The study shows that despite the well-defined basis for managing CES, we noted a greater number of patients with sequels caused by this condition, than is seen in the literature. The delayed diagnosis and, consequently, delayed treatment, were the main causes for the results observed. Level of Evidence IV, Case Series.

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Cauda Equina Syndrome

Abstract: In our series, the symptom duration before operation and the speed of onset do not affect the outcome more than 2 years after surgery. Based on the SF-36, ODI, and Low Back Outcome Scores, patients who have had CES do not return to a normal status.

Cited by 131 publications

References 49 publications

The long term outcome of micturition, defecation and sexual function after spinal surgery for cauda equina syndrome

The long term outcome of micturition, defecation and sexual function after spinal surgery for cauda equina syndrome

Complaints of micturition, defecation and sexual function in cauda equina syndrome due to lumbar disk herniation: a systematic review

Estudo epidemiológico da síndrome da cauda equina

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