Long-term rates of bladder dysfunction after decompression in patients with cauda equina syndrome

Abstract Background Spontaneous conus medullaris infarction is a rare disease. We describe two patients with spontaneous conus medullaris infarction presenting as acute cauda equina syndrome and their unique electromyography (EMG) findings. Case presentation Two patients developed acute low back pain with mild asymmetric paraparesis, loss of perianal sensation and sphincter dysfunction. Ankle deep tendon reflexes were reduced in bilaterally. Neither patient had cardiovascular risk factors. Magnetic Resonance imaging showed infarction in the conus medullaris. Functional recovery was good in both patients, but progressive asymmetric calf wasting and sphincter dysfunction remained. EMG studies at follow-up of at least 3 years demonstrate active denervation at the muscles innervated by the first sacrum anterior horn cells. Conclusion Spontaneous conus medullaris infarction can occur in healthy individuals and presents as cauda equina syndrome. Findings of needle EMG studies indicate a progressive course of sacrum anterior horn cell disorder during long-term follow-up.

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Prediction of the outcome of bladder dysfunction based on electrically induced reflex findings in patients with cauda equina syndrome

Medicine ◽

10.1097/md.0000000000007014 ◽

2017 ◽

Vol 96 (21) ◽

pp. e7014 ◽

Cited By ~ 4

Author(s):

Dong Gyu Lee ◽

Sang Gyu Kwak ◽

Min Cheol Chang

Keyword(s):

Cauda Equina Syndrome ◽

Bladder Dysfunction ◽

Cauda Equina

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Retrospective cohort study with prospective long-term follow-up in cauda equina syndrome

The Spine Journal ◽

10.1016/j.spinee.2016.12.049 ◽

2017 ◽

Vol 17 (3) ◽

pp. S15-S16

Author(s):

Adam Devany ◽

Steele Nick ◽

Marya Shivan ◽

Gill Damien ◽

Crawford Robert ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Cauda Equina Syndrome ◽

Retrospective Cohort ◽

Cauda Equina ◽

Long Term Follow Up

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

Topics in Spinal Cord Injury Rehabilitation ◽

10.46292/sci19-00065 ◽

2020 ◽

Vol 26 (4) ◽

pp. 290-303

Author(s):

Jordan Lam ◽

Ruth-Mary deSouza ◽

Jonathan Laycock ◽

Duranka Perera ◽

Charlotte Burford ◽

...

Keyword(s):

Quality Of Life ◽

Sexual Dysfunction ◽

Intervertebral Disc ◽

Sexual Function ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Bladder Function ◽

Patient Reported

Background: Cauda equina syndrome (CES) is rare neurosurgical emergency requiring emergent surgical decompression to prevent bladder, bowel, and sexual dysfunction that can have significant impact on quality of life. There is a paucity of data relating to the prevalence of these long-term complications. Objective: The aim of this observational study was to evaluate the long-term prevalence of CES-related bladder, bowel, and sexual dysfunction and impact on quality of life to inform service provision. Methods: Participants were selected through coding of operative records of patients who underwent lumbar decompression for CES secondary to a herniated intervertebral disc at two large UK neurosurgical departments between 2011 and 2015 inclusive. A telephone-based survey including both validated and modified tools was used to collect data pertaining to bladder, bowel, and sexual function and impact on quality of life both before development of CES and at the time of the survey, at least 1 year postoperatively. Results: Of 135 patients contacted, 71 (42 male, 29 female) responded. Post-CES compared to pre-CES, there was higher prevalence and significant intrarespondent deterioration of bowel dysfunction, bladder dysfunction, perception of bladder function, sexual function, effect of back pain on sex life, and activities of daily living/quality of life (p < .0001 for all). Significant differences in individual questions pre-CES versus post-CES were also found. Conclusion: We show high prevalence of long-term bowel, bladder, and sexual dysfunction post-CES, with functional and psychosocial consequences. Our results demonstrate the need for preoperative information and subsequent screening and long-term multidisciplinary support for these complications.

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Physical Examination Is Predictive of Cauda Equina Syndrome: MRI to Rule Out Diagnosis Is Unnecessary

Global Spine Journal ◽

10.1177/2192568220948804 ◽

2020 ◽

pp. 219256822094880

Author(s):

Natalie L. Zusman ◽

Stephanie S. Radoslovich ◽

Spencer B. S. Smith ◽

Mary Tanski ◽

Kenneth R. Gundle ◽

...

Keyword(s):

Physical Examination ◽

Cauda Equina Syndrome ◽

Bladder Dysfunction ◽

Medical Center ◽

Academic Medical Center ◽

Effective Means ◽

Cauda Equina ◽

Cross Sectional ◽

Predictive Values ◽

Rectal Tone

Study Design: Cross-sectional cohort study. Objectives: Cauda equina syndrome (CES) is a neurologic emergency, and delay in diagnosis can result in irreversible impairment. Our purpose was to determine the value of physical examination in diagnosis of CES in patients complaining of bladder and/or bowel complications in the emergency department. Methods: Adult patients at one tertiary academic medical center that endorsed bowel/bladder dysfunction, underwent a lumbar magnetic resonance imaging (MRI), and received an orthopedic spine surgery consultation from 2008 to 2017 were included. Patients consulted for trauma or tumor were excluded. A chart and imaging review was performed to collect demographic, physical examination, and treatment data. Sensitivity, specificity, and negative and positive predictive values were calculated, and fast-and-frugal decision trees (FFTs) were generated using R. Results: Of 142 eligible patients, 10 were diagnosed with CES. The sensitivity and specificity of the exam findings were highest for bulbocavernosus reflex (BCR) (100% and 100%), followed by rectal tone (80% and 86%), postvoid residual bladder (80% and 59%), and perianal sensation (60% and 68%). The positive predictive value was high for BCR (100%), but low for other findings (13% to 31%). However, negative predictive values were consistently high for all examinations (96% to 100%). Two FFTs utilizing combinations of voluntary rectal tone, perianal sensation, and BCR resulted in no false negatives. Conclusions: A combination of physical examination findings of lower sacral function is an effective means of ruling out CES and, with further study, may eliminate the need for MRI in many patients reporting back pain and bowel or bladder dysfunction.

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Cauda equina syndrome due to disk herniation: Long-term functional prognosis

Neurocirugía ◽

10.1016/j.neucir.2019.05.002 ◽

2019 ◽

Vol 30 (6) ◽

pp. 278-287 ◽

Cited By ~ 1

Author(s):

Pedro David Delgado-López ◽

Javier Martín-Alonso ◽

Vicente Martín-Velasco ◽

José Manuel Castilla-Díez ◽

Ana Galacho-Harriero ◽

...

Keyword(s):

Cauda Equina Syndrome ◽

Cauda Equina ◽

Disk Herniation

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P84 Cauda equina syndrome – an assessment of long-term outcomes following surgery

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.141 ◽

2019 ◽

Vol 90 (3) ◽

pp. e43.4-e44

Author(s):

JE Hazelwood ◽

I Hoeritzauer ◽

A Demetriades

Keyword(s):

Physical Function ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Bowel Dysfunction ◽

Long Term Outcomes ◽

Symptom Profile ◽

Post Operative Pain ◽

Current Symptom ◽

Physical Dysfunction

ObjectivesData regarding long-term outcomes following surgery for cauda equina syndrome (CES) is scarce, especially concerning bowel and sexual function. This study aimed to assess long-term bladder, bowel, sexual and physical function in a CES cohort.DesignDescriptive.SubjectsA pre-existing ethically approved database was used to identify patients who had undergone surgery for CES between August 2013-November 2014.MethodsPatients were contacted over a one month period and completed validated questionnaires via telephone. These assessed bladder (Urinary Symptom Profile), bowel (Neurogenic Bowel Dysfunction Score), sexual (Arizona Sexual Experiences Scale) and physical function (SF-12). Patients were also asked which of their current symptoms they would most value treatment for and which NHS services they had accessed post-operatively.ResultsForty-six of 77 patients (response rate 72%, inclusion rate 59%) 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 41% with the majority (87%) reporting very minor symptoms, sexual dysfunction 39% and physical dysfunction 48%. Pain was the most deleterious current symptom in 57% but only 7% reported post-operative pain-management referral.ConclusionsThese findings confirm the high prevalence of long-term bladder, bowel, sexual and physical dysfunction in CES patients and provide useful data to guide the expectations of patients and clinicians.

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