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

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.

scholarly journals An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome

2019 ◽  
Vol 161 (9) ◽  
pp. 1887-1894 ◽  
Author(s):  
J. E. Hazelwood ◽  
I. Hoeritzauer ◽  
S. Pronin ◽  
A. K. Demetriades
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Long Term Outcomes ◽  
Patient Reported

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

2021 ◽  
Author(s):  
Henry Seidel ◽  
Sarah Bhattacharjee ◽  
Sean Pirkle ◽  
Lewis Shi ◽  
Jason Strelzow ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Bladder Dysfunction ◽  
Cauda Equina

scholarly journals Outcome of Delayed Decompression Surgery for Cauda Equina Syndrome secondary to Lumbar Disc Herniation: A Case Report

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Lim SM ◽  
Johari J ◽  
Yusof MI
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Bowel Dysfunction ◽  
Decompression Surgery ◽  
Motor Weakness ◽  
Post Surgery ◽  
Maximum Improvement

Cauda equina syndrome (CES) is a constellation of symptoms which consist of low back pain, sciatica, saddlearea paraesthesia, urinary or faecal incontinence, with or without motor weakness, and sensory deficit. Surgical decompression is indicated as soon as possible, as decompression within 48 hours from onset allows maximum improvement of symptoms. Recovery usually occurs months or years postoperatively. We report a case of a patient with cauda equina syndrome secondary to massive lumbar disc herniation who had undergone urgent decompression one week after onset of urinary and bowel dysfunction. The clinical outcome post surgery was also discussed.

scholarly journals Long-term mental wellbeing and functioning after surgery for cauda equina syndrome

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255530
Author(s):  
James E. Hazelwood ◽  
Ingrid Hoeritzauer ◽  
Alan Carson ◽  
Jon Stone ◽  
Andreas K. Demetriades
Keyword(s):  
Mental Health ◽  
At Risk ◽  
Cauda Equina ◽  
Mental Wellbeing ◽  
Physical Dysfunction ◽  
Related Quality ◽  
Health Related

Introduction Cauda Equina Syndrome (CES) can cause persisting life-changing dysfunction. There is scarce literature regarding the long-term assessment of CES symptoms, and rarer still is the impact of these symptoms on mental wellbeing investigated. This study assessed the long-term patient reported mental wellbeing outcomes of post-operative CES patients. Methods Patients who underwent surgery for CES between August 2013 and November 2014 were identified using an ethically approved database. They then completed validated questionnaires over the telephone assessing their mental and physical functioning (Short-Form 12 Questionnaire), generating the Physical Component Summary (PCS) and Mental Component Summary (MCS). Bladder, bowel and sexual function were also assessed using validated questionnaires. MCS scores were compared to both the Scottish mean and previously published cut-offs indicating patients at risk of depression. Correlations of MCS with bladder, bowel, sexual and physical dysfunction were examined and multifactorial regression to predict MCS from these variables analysed. Independent t-tests assessed the mean difference in MCS between patients presenting with incomplete CES (CES-I) and CES with retention (CES-R) and between those with radiologically confirmed and impending CES. Results Forty-six participants with a mean follow-up time of 43 months completed the study. The mean (±SD) MCS was 49 (±11.8) with 22% demonstrating poor mental health related quality of life in comparison to the Scottish mean. Overall, 37% had scores consistent with being at risk for depression with in the last 30 days, and 45% within the last 12 months. MCS was significantly correlated with Urinary Symptoms Profile (USP) score (-0.608), NBDS score (-0.556), ASEX score (-0.349) and PCS score (0.413) with worse bladder, bowel, sexual and physical dysfunction associated with worse MCS score. Multifactorial regression analysis demonstrated both urinary (USP score p = 0.031) and bowel function (NBDS score p = 0.009) to be significant predictive variables of mental health related quality of life. There were no significant mean differences in MCS between those presenting with CES-I and CES-R or those with radiologically complete and impending CES. Discussion This study demonstrates a high frequency of being at risk for depression in patients with CES and identifies outcome measures (physical, sexual and more so bladder and bowel dysfunction) associated with poorer mental wellbeing. Our large cohort and long follow-up highlight that CES patients should be considered at risk of depression, and the need to consider mental health outcomes following CES surgery.

Infographic: Long-term core outcomes in cauda equina syndrome

2021 ◽  
Vol 103-B (9) ◽  
pp. 1462-1463
Author(s):  
T. P. Barker ◽  
N. Steele ◽  
G. Swamy ◽  
A. Cook ◽  
A. Rai ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Core Outcomes

Robotic surgery in gynecology

2012 ◽  
Vol 153 (25) ◽  
pp. 967-972
Author(s):  
Roland Csorba
Keyword(s):  
Robotic Surgery ◽  
Gynecologic Oncology ◽  
Surgical Approaches ◽  
Long Term Outcomes ◽  
Post Operative Pain ◽  
Surgical Methods ◽  
Adnexal Surgery ◽  
The Right ◽  
Oncologic Diseases

Minimally invasive surgery has revolutionized gynecological interventions over the past 30 years. The introduction of the da Vinci robotic surgery in 2005 has resulted in large changes in surgical management. The robotic platform allows less experienced laparoscopic surgeons to perform more complex procedures. It can be utilized mainly in general gynecology and reproductive gynecology. The robot is being increasingly used for procedures such as hysterectomy, myomectomy, adnexal surgery, and tubal anastomosis. In urogynecology, the robot is being utilized for sacrocolopexy as well. In the field of gynecologic oncology, the robot is being increasingly used for hysterectomy and lymphadenectomy in oncologic diseases. Despite the rapid and widespread adaption of robotic surgery in gynecology, there are no randomized trials comparing its efficacy and safety to other traditional surgical approaches. This article presents the development, technical aspects and indications of robotic surgery in gynecology, based on the previously published reviews. Robotic surgery can be highly advantageous with the right amount of training, along with appropriate patient selection. Patients will have less blood loss, less post-operative pain, faster recovery, and fewer complications compared to open surgery and laparoscopy. However, until larger randomized control trials are completed which report long-term outcomes, robotic surgery cannot be stated to have priority over other surgical methods. Orv. Hetil., 2012, 153, 967–972.

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

PLoS ONE ◽  
2017 ◽  
Vol 12 (4) ◽  
pp. e0175987 ◽  
Author(s):  
Nina S. Korse ◽  
Anna B. Veldman ◽  
Wilco C. Peul ◽  
Carmen L. A. Vleggeert-Lankamp
Keyword(s):  
Sexual Function ◽  
Spinal Surgery ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Clinical, neuroimaging, and nerve conduction characteristics of spontaneous Conus Medullaris infarction

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yi-Ching Weng ◽  
Shy-Chyi Chin ◽  
Yah-Yuan Wu ◽  
Hung-Chou Kuo
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Anterior Horn ◽  
Case Presentation ◽  
Acute Low Back Pain ◽  
Long Term Follow Up ◽  
Cell Disorder

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.

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

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

scholarly journals Cauda Equina Syndrome Retention Type –Late Intervention Can also give Excellent Results

2020 ◽  
pp. 1-4
Author(s):  
Suhasish Roy ◽  
◽  
Siddhartha Mahapatra ◽  
Keyword(s):  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Golden Rule ◽  
Complete Recovery ◽  
Neurological Status ◽  
Bowel Dysfunction ◽  
Caries Spine ◽  
Bladder Bowel Dysfunction

Introduction: Cauda Equina Syndrome (CES) is an acute stenosis of lumbar spinal canal leading to compression of neural elements below the level of L1 mostly due to disc herniation but other causes exist. Intervention within 48 hours prevent permanent sensorimotor, sphincter and sexual disturbances. We reporttwelvecases of Cauda Equina Syndrome with complete sensorimotor deficit, bladder, bowel dysfunction intervened at least 1 month after initiation of symptoms with complete recovery of functions. Till date a few literature support is there to substantiate this evidence. Methods: 22 patients between 2011 to 2015, 18 male and 4 female, attended with complete or retention type of cauda equina syndrome. Of the 8 men, 5 had acute discherniations, 2 had caries spine, 1 had trauma. Of the 4 women,3 had acute disc herniation,1 had caries spine. 4 attended 35- 39 days, 4 between 45- 45 days,4 between 45- 60 days. They were urgently decompressed within 72 hours of attendance. 4 were lost in follow- up within 1 year. Rest were followed up3- 5 years. Results: 3 patients improved by 14 to 28 days, their neurological status improved from ASIA A to ASIA D, 4 patients by 30 to 90 days from ASIA A to ASIA E. 1 male patient improved from ASIA A to ASIA C in 3 years. All the above neurological status maintained. 2 men and 2 women were lost to follow up within 1 year when their improvement were by only one grade in ASIA impairment scale. 7 out of 8 patients had excellent results. Conclusion: Though early intervention is the golden rule, in late presentations of complete cauda equine syndrome, thorough decompression improves the neurological status of the patient

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