Examination of The Predictive Power of Electromyography and Urodynamic Study in Patients with Cauda Equina Syndrome (Horse Tail Syndrome)

Abstract

Background:Cauda equina syndrome is a rare disorder that causes loss of Lumbar plexus function (nerve roots) lower than conus medullaris. No risk factor has been defined for this disease yet. Due to the high morbidity of Cauda equina syndrome and lack of sufficient information about the connection between the disease and urodynamic findings and EMG (Electromyography) findings, the need for this comprehensive study is felt.Objective:The aim is to determine the predictive power of findings resulted from urodynamics and electromyography of perineal region and around sphincter in the clinical cure rate of urination in patients with urinary retention followed by Cauda equina syndrome.Method:Patients referred to Shohadaye Tajrish Hospital during the years 2009 to 2013, in case of having Cauda equina syndrome symptoms (confirmed with Lumbar MRI), were undergone urodynamic examination and perineal electromyography after surgical decompression action. These both assessments (urodynamic study and electromyography) were repeated during the follow-up of 15 patients in the first and sixth months after surgery and findings were compared with each other.Results:Among the Urodynamic findings, Qmax (maximum urine flow) during three studies had a significant relationship with long-term recovery rate of patients (P <0.05). The relationship had been more valuable in follow-ups after one month (P = 0.0001). Also, BCI (Bladder Contractility Index) in all three studies had a significant relationship with clinical improvement in the ability to urinate (P <0.001). The residual urine (PVR) compared to two previous urodynamic findings showed a less significant relationship with clinical cure rate (P = 0.04). Among the findings of muscle-nerve (MUAP Fibrillation, Positive sharp way) none of them had a significant relationship with cure rate.Conclusion:Urodynamic finding, especially Qmax and bladder contractility index, can be considered as predictive indicators for patients’ recovery after surgery.

Patient-Reported Bladder, Bowel, and Sexual Function After Cauda Equina Syndrome Secondary to a Herniated Lumbar Intervertebral Disc

“…In addition to clinical assessment-based tools, urodynamic and electromyographical tools have also been shown to predict bladder dysfuction outcomes, including electrically induced bulbocavernosus reflex, Qmax and Bladder Contractility Index. 23,24 The importance of a proactive approach is highlighted by Korse et al who recently reviewed literature sources reporting improvement in micturition, defecation, and sexual dysfunction occuring for several years post-CES. 6 This argues for a rehabilitation-focused approach toward patients with post-CES dysfunction rather than a passive approach of monitoring and symptom control.…”

Cauda equina syndrome in dogs - a review

“…Electrodiagnostic studies, especially electromyography and somatosensory evoked potentials, routinely employed in human neurology, are gaining growing popularity in veterinary medicine, as well (Shahmohammadi et al 2016). Electromyography which is able to identify the impaired neural conduction to muscles of pelvic extremities, perineum and tail can be very helpful in differential diagnosis between CES and orthopeadic diseases mimicking this clinical entity.…”

“…While the hip dysplasia is an orthopaedic disease characterized by joint laxity, grinding, pain and/or reduced range of motion in the coxo-femoral joint, but missing a neurological deficit, the fully developed CES reveals typical symptomatology of a L7-Cd5 spinal nerve roots lesion (Dewey 2008;Suwankong et al 2008;Lorenz et al 2011). The definite diagnosis may require X-rays, CT or MRI examination as well as electrodiagnostic studies which are able to exclude the nerve root entrapment (Szilasiová 2011;Shahmohammadi et al 2016).…”