Outcome of spinal decompression in cauda equina syndrome presenting late in developing countries: case series of 50 cases

Abstract

The purpose of this study is to find the clinical outcome of decompression of Cauda Equina presenting late in the course of disease. There were 33 males and 17 females with average age of 48 years, ranging from 25 to 85 years. All patients presented to us with a fully developed Cauda Equina syndrome (CES). All of them presented late with mean delay of 12.2 days. Time interval between bladder and bowel dysfunction and admission to hospital varied from 1 to 35 days. The average follow-up was 34.5 months, ranging from 12 to 60 months. There was no statistically significant difference in time of delay in surgery between the recovered and non-recovered group as tested by Student's t test. But there was a statistically significant positive correlation between duration taken for total recovery and delay in surgery. Anal wink as a predictor of bladder and bowel recovery also showed statistical significance, as patients with an absence had a poorer prognosis for bladder recovery. The result of surgery in CES is not as dramatic and fast as seen after routine disc surgery. Some improvement can be expected with decompression even in those patients presenting late and results are not universally poor as previously thought. The treating physicians of such patients should be aware that the recovery in this group of patients can take an exceptionally long time and hence should involve in constant reassurance and rehabilitation of the patient. Presence of anal wink is a very good predictor of bladder and bowel recovery.

Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

“…This results in a shorter duration of CES complaints (patient delay) as well as a shorter time to decompression (doctor delay), even though outcome is poor (due to the extent of the lesion). Patients that show reasonable outcome when decompression is delayed by weeks [31], probably had a favourable anatomical lesion and more gradual onset of complaints. Since it is not (yet) possible to distinguish the group with the favourable conditions from the group with the less favourable conditions at the time of presentation (since, e.g., the exact correlation of clinical presentation and degree of canal obstruction on imaging is not yet known), it is necessary to decompress every CES patient as soon as possible, to create the best chances for fair recovery.…”

Disorders of the Cauda Equina

“…The commonly quoted time frame in which decompression of diskogenic cauda equina syndrome should take place is within 48 hours from symptom onset. 26 In this study, decompression of the cauda equina was delayed by a mean of 12.2 days, with a delay of 35 days in one patient. 23,25 The data on late decompression were provided by a study performed in India in a setting in which spine surgeons are not routinely available.…”

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2013

“…They suspected that further improvement would occur, as indeed the paper by Dhatt et al [5] showed in his review some 2 years ago. They looked at the outcome of spinal decompression in cauda equina syndrome presenting late, in developing countries in 50 patients.…”