Does Early Surgical Decompression in Cauda Equina Syndrome Improve Bladder Outcome?

Spine ◽  
2015 ◽  
Vol 40 (8) ◽  
pp. 580-583 ◽  
Author(s):  
Nisaharan Srikandarajah ◽  
Matthew Alexander Boissaud-Cooke ◽  
Simon Clark ◽  
Martin John Wilby
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Surgical Decompression

scholarly journals Late presentation of a cauda equina lesion with a vulval abscess: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Chanil Deshan Ekanayake ◽  
Deepal Weerasekera ◽  
Dilini Dissanayake ◽  
Ranga Wickramarachchi ◽  
Saman Pushpakumara ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Late Presentation ◽  
Surgical Decompression ◽  
Lower Limbs ◽  
Sensory Loss ◽  
Postoperative Rehabilitation ◽  
Indwelling Catheter ◽  
Distended Bladder ◽  
Tract Infections

Abstract Background Cauda equina syndrome is a rare clinical condition that requires prompt diagnosis and timely surgical decompression with postoperative rehabilitation to prevent devastating complications. Case presentation A 55-year-old Sinhalese woman presented with a vulval abscess, with a history of involuntary leakage of urine for the last 7 years. Her sexual activity has been compromised due to coital incontinence, and she had also been treated for recurrent urinary tract infections during the last 7 years. On examination, a distended bladder was found. Neurological examination revealed a saddle sensory loss of S2–S4 dermatomes. There was no sensory loss over the lower limbs. Bladder sensation was absent, but there was some degree of anal sphincter tone. Motor functions and reflexes were normal in the limbs. Magnetic resonance imaging revealed L5–S1 spondylolisthesis. Ultrasound imaging confirmed the finding of a distended bladder, in addition to bilateral hydroureters with hydronephrosis. An incision and drainage with concomitant intravenous antibiotics were started for the vulval abscess. An indwelling catheter was placed to decompress the bladder and to reduce vulval excoriations due to urine. Bilateral ureteric stenting was performed later for persistent hydronephrosis and hydroureter despite an empty bladder. Conclusion This is a tragic case that illustrates the devastating long-term sequelae that ensues if cauda equina syndrome is left undiagnosed. It reiterates the importance of prompt referral and surgical decompression.

Cauda equina syndrome secondary to an absent inferior vena cava managed with surgical decompression

2012 ◽  
Vol 16 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Mayshan Ghiassi ◽  
Mahan Ghiassi ◽  
Elyne Kahn ◽  
Luke Tomycz ◽  
Michael Ayad ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Cauda Equina Syndrome ◽  
Inferior Vena ◽  
Cauda Equina ◽  
Vena Cava ◽  
Signs And Symptoms ◽  
Surgical Decompression ◽  
Steroid Administration ◽  
Initial Improvement ◽  
Full Neurological Recovery

The authors report on the case of a 24-year-old man who presented with back pain and radiculopathy due to epidural venous engorgement in the setting of a congenitally absent inferior vena cava. Despite initial improvement after steroid administration, the patient's health ultimately declined over a period of weeks, and signs and symptoms of cauda equina syndrome manifested. Lumbar decompression was performed and involved coagulation and resection of the compressive epidural veins. No complications occurred, and the patient made a full neurological recovery.

scholarly journals Cauda equina syndrome secondary to lumbar disc herniation. Report of three cases

2013 ◽  
Vol 20 (3) ◽  
pp. 261-266
Author(s):  
Danil Adam ◽  
Ioana Hornea
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Surgical Decompression ◽  
Pathophysiological Mechanism ◽  
Lumbar Intervertebral Disc ◽  
Maximum Improvement ◽  
Lumbar Spinal

Abstract Cauda equina syndrome produced by the herniated lumbar intervertebral disc is a rare disorder that, if is undiagnosed and untreated in time, can have serious consequences for the patient and medicolegal implications for the surgeon. We report the clinical evolution of 3 patients with lumbar spinal stenosis who still present sphincterian and sexual dysfunctions many years after surgery, even if they were operated on immediately after admission. Reviewing the literature on this subject has allowed us to emphasize symptomes, pathophysiological mechanism and management regarding patients with lumbar spinal stenosis. The surgical decompression is indicated as soon as possible. The surgical decompression within 48 hours from onset allows maximum improvement of symptoms and absolves the surgeon of any medico-legal liability

P149. Timing of surgical decompression for cauda equina syndrome

2019 ◽  
Vol 19 (9) ◽  
pp. S227
Author(s):  
Eren O. Kuris ◽  
William B. Hogan ◽  
Wesley Durand ◽  
Shyam A. Patel ◽  
Adam Eltorai ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Surgical Decompression

scholarly journals Does surgical decompression alleviate neglected cauda equina syndromes attributed to lumbar disc herniation and/or degenerative canal stenosis?

2020 ◽  
Vol 11 ◽  
pp. 278
Author(s):  
Sulaiman Sath
Keyword(s):  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Surgical Decompression ◽  
Bladder Function ◽  
Disc Disease ◽  
Residual Symptoms ◽  
Canal Stenosis ◽  
Complete Restoration ◽  
Disc Herniations

Background: Most studies recommend urgent decompression (e.g., within 48–72 h) of the symptomatic onset of a cauda equina syndrome. As patients in our area typically underwent >3 months delayed surgery for cauda equina syndromes due to disc disease/stenosis, we asked whether surgery was still worthwhile. Methods: This was a retrospective analysis of 12 patients (2012–2018) who underwent delayed surgical decompression for cauda equina syndromes secondary to lumbar disc herniations and/or degenerative lumbar canal stenosis. Results: After a mean postoperative duration of 8.22 months, nine patients experienced the complete restoration of bladder status; two patients required intermittent self-catheterization, while one patient had some residual symptoms (e.g., urgency but able to void with some difficulty). Conclusion: For 12 patients who originally presented with cauda equina syndrome with complete incontinence, nine exhibited delayed full recovery of bladder function with average of 8.22 months postoperatively. We would, therefore, advise that delayed surgical decompression be offered to these patients, irrespective of the preoperative duration of cauda equina syndromes with complete incontinence.

scholarly journals Documentation of Focal Neurology on Patients with Suspected Cauda Equina Syndrome and the Development of an Assessment Proforma

2015 ◽  
Vol 9 (1) ◽  
pp. 390-394 ◽  
Author(s):  
Nisarg Mehta ◽  
David Garbera ◽  
Jeremy Kaye ◽  
Muthukrishnan Ramakrishnan
Keyword(s):  
Neurological Examination ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Rare Condition ◽  
Surgical Decompression ◽  
Retrospective Case ◽  
Female Ratio ◽  
Accident And Emergency ◽  
Department Evaluation ◽  
Male To Female

Objective : Cauda equina syndrome is a relatively rare condition with a disproportionately high medico legal profile. Definitive management involves prompt surgical decompression with outcome dependent on timing of surgery. Documentation of a comprehensive clinical and neurological assessment including examination of anal tone and perianal sensation is essential in reducing litigation and identifying patients requiring urgent surgical decompression. The aim of this study was to evaluate the documentation of focal neurology in patients with suspected cauda equina syndrome and devise an assessment proforma to use in the accident and emergency departments. Methods : A retrospective case note review was performed in all patients presenting to A&E with suspected cauda equina syndrome from January 2013 to March 2014. A full neurological examination was defined as having all modalities documented such as: MRC grade power, reflexes, sensory exam, vibration proprioception, anal tone & perianal sensation. Results : Sixty-nine patients with suspected cauda equina syndrome were identified with a median age of 44 (35-55) and a male to female ratio of 1:1.6. 4 patients (6%) had confirmed cauda equina syndrome and were transferred to a tertiary neurosurgical centre for further management. Only 2 patients (3%) had a complete neurological examination documented. 11 (16%) patients did not have any documentation of perianal sensation and 8 patients (12%) did not have documentation of anal tone Conclusion : Documentation of neurological was poor across our department. The introduction of an assessment proforma is proposed to increase documentation and optimise emergency department evaluation in these patients.

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