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 The role of surgical decompression of Cauda equina in lumbar disc herniation in recovery of bladder function

2004 ◽  
Vol 57 (7-8) ◽  
pp. 327-330 ◽  
Author(s):  
Danilo Radulovic ◽  
Goran Tasic ◽  
Milos Jokovic ◽  
Igor Nikolic
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Surgical Decompression ◽  
Bladder Function ◽  
Duration Of Symptoms ◽  
Significant Difference

INTRODUCTION Cauda equina syndrome from lumbar disc herniation accounts for up to 2-3% of all disc herniations. The aim of this study was to investigate whether recovery of bladder function after surgery depends on preoperative duration of disease. Patients and methods This retrospective study included 47 patients who underwent surgery for cauda equina syndrome due to a herniated disc in the period between 1997 and 2002. Eleven patients were female and 36 male, with a mean age of 43 years (range 23-67). All presented with sciatica and saddle hypoesthesia, whereas 13 presented with motor weakness of legs. All patients had been catheterized at the time of admission to the Neurosurgical unit. Levels of herniation were L4-L5 in 27 (57%), L5-S1 in 14 (30%), and L3-L4 in 6 (13%) patients. In 7 (15%) patients, surgery was performed within 48 hours of the cauda equina syndrome onset. None underwent surgery within 24 hours. 13 (28%) patients were operated between the 2nd and 7th day and 27 (57%) after 7th day of the cauda equina onset. The role of preoperative duration of symptoms in recovery of bladder function was examined (chi 2 analysis). RESULTS The follow-up ranged from 15 to 74 months (mean 24.2 months). In 33 patients (70%) excellent result were achieved, in 9 (19%) patients good results and 5 (11%) patients presented with poor results. There was no statistically significant difference concerning the time between the onset of symptoms and surgical decompression and subsequent recovery of bladder function (p>0.05). CONCLUSION After accurate diagnosis and adequate operative treatment, postoperative results of cauda equina syndrome due to lumbar disc herniation appear satisfactory regardless of the timing of surgery.

scholarly journals Cauda Equina Syndrome after Sequestered Disc Herniation Migrating to the Dorsal Epidural Space: Case Report and Review of the Literature

2020 ◽  
pp. 1-2
Author(s):  
Abdullah Alshammari ◽  
Abdullah Alshammari ◽  
Michael Weber ◽  
Rodrigo Navarro-Ramirez ◽  
Susan Ge
Keyword(s):  
Epidural Space ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Foot Drop ◽  
Low Back ◽  
Decompressive Laminectomy ◽  
Safe Management ◽  
Disc Herniations ◽  
Space Case

Background: Posteriorly migrated epidural disc fragments (PMEDF) presenting with cauda equina syndrome are relatively common. These cases are sometimes inaccurately identified on MRI as; epidural tumors, abscesses, hematomas and or facet cysts. Proper description and identification are key to be able to provide effective and safe management. Currently we are presenting the case of a patient with cauda equina syndrome secondary to a posterior mass compression intraoperatively identified as a PMEDF. Case Description: 45-years-old male presenting with insidious low back pain that progressed to urinary retention and bilateral foot drop. An MRI of the lumbar spine showed a posteriorly located epidural lesion. That appeared to be dependent on a left facet cyst. The patient was treated with a decompressive laminectomy and multiple disc fragments were identified under the ligamentum flavum and over the posterior epidural space. Conclusion: Posterior epidural migration of a lumbar disc fragments (PEMLDF) are not a common presentation of intervertebral disc herniations and their differential diagnosis and treatment might require a different surgical approach; fusion vs decompression. PEMLDFs should be suspected on those patients presenting with sudden cauda equina syndrome and posteriorly located epidural lesions on MRI.

Cauda Equina Syndrome in Lumbar Disc Disease

1980 ◽  
Vol 51 (1-6) ◽  
pp. 493-499 ◽  
Author(s):  
A. R. Choudhury ◽  
J. C. Taylor
Keyword(s):  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Disc Disease ◽  
Lumbar Disc Disease

Epidural abscess and cauda equina syndrome after percutaneous intradiscal therapy in degenerative lumbar disc disease

2012 ◽  
Vol 12 (11) ◽  
pp. e1-e4 ◽  
Author(s):  
Brian R. Subach ◽  
Anne G. Copay ◽  
Marcus M. Martin ◽  
Thomas C. Schuler ◽  
Diana S. DeWolfe
Keyword(s):  
Cauda Equina Syndrome ◽  
Epidural Abscess ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Disc Disease ◽  
Lumbar Disc Disease

scholarly journals Posterior epidural migration of a lumbar disc herniation

2020 ◽  
Vol 11 ◽  
pp. 4
Author(s):  
Meryem Himmiche ◽  
Khalid Chakour ◽  
Mohammed El Faiz Chaoui ◽  
Mohammed Benzagmout
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Low Back ◽  
Case Description ◽  
Disc Material ◽  
Disc Herniations ◽  
History Of

Background: Posterior epidural migration of a lumbar disc fragment (PEMLDF) refers to the dorsal migration of disc material around the thecal sac that can lead to radiculopathy and/or cause a cauda equina syndrome. It is rare and the diagnosis is often just established intraoperatively. Case Description: A 50-year-old male with a chronic history of low back pain and psychosis presented with PEMLDF originating at the L4–L5 level. Conclusion: Lumbar disc herniations rarely present as PEMLDF resulting in symptoms varying from radiculopathy to cauda equina syndrome. These should be included among the differential diagnostic considerations for dorsolateral epidural lesions.

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

Cauda Equina Syndrome (CES) From Lumbar Disc Herniations

2009 ◽  
Vol 22 (3) ◽  
pp. 202-206 ◽  
Author(s):  
William C. Olivero ◽  
Huan Wang ◽  
William C. Hanigan ◽  
John P. Henderson ◽  
Patrick T. Tracy ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Disc Herniations

Intradural lumbar disc herniations associated with cauda equina syndrome: report of two cases and review of literature

Chirurgia ◽  
2017 ◽  
Vol 30 (5) ◽  
Author(s):  
Massimiliano Gallo ◽  
Gianfilippo Caggiari ◽  
Leonardo Puddu ◽  
Emanuele Ciurlia ◽  
Giulia R. Mosele ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Review Of Literature ◽  
Disc Herniations ◽  
Syndrome Report

scholarly journals Delayed presentation of cauda equina syndrome secondary to lumbar disc herniation: functional outcomes and health-related quality of life

CJEM ◽  
2001 ◽  
Vol 3 (04) ◽  
pp. 285-291 ◽  
Author(s):  
Jason W. Busse ◽  
Mohit Bhandari ◽  
Joseph B. Schnittker ◽  
Kesava Reddy ◽  
R. Brett Dunlop
Keyword(s):  
Quality Of Life ◽  
Functional Status ◽  
Cauda Equina Syndrome ◽  
Functional Outcomes ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Surgical Decompression ◽  
Symptom Duration ◽  
Sf 36

ABSTRACTObjective:Cauda equina syndrome (CES) is a feared complication of lumbar disc herniation. It is generally accepted that CES requires decompression within 6 hours of symptom onset, but this time goal is rarely met, and the relative benefit of delayed decompression on functional status and quality of life (QOL) remains unknown. The study objective was to describe the functional status and quality of life outcomes for patients who undergo delayed surgical decompression for CES.Methods:Patients with CES who underwent decompression of a herniated lumbar disc during a 10-year period were assessed at hospital discharge and at least 4 months after the procedure. Evaluation of functional outcomes was based on a previously validated scale and QOL outcomes on the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) questionnaire.Results:During the study period, 1100 patients with herniated discs were identified, and 14 underwent surgical decompression for CES. All 14 had had symptoms for more than 38 hours before surgery. Ten patients were available for long-term follow-up. There was a strong correlation between long CES symptom duration and poor functional outcome: of 8 patients with symptoms for less than 10 days before decompression (range, 1.6–7.5 d), all had good functional outcomes. The 2 patients with more prolonged symptoms (10.6 and 14.2 d) had poor outcomes. SF-36 scores demonstrated declines in physical roles (p= 0.03), social function (p= 0.03) and increased pain (p= 0.003) compared with population norms. Correlation between SF-36 domain scores and CES symptom duration failed to achieve statistical significance, perhaps because of small sample size.Conclusions:Patients who undergo delayed decompression for CES have increased pain and impaired social and physical function. Longer delays correlate with worse functional outcomes. Beyond 24 hours, decompression delay may be associated with a poorer quality of life but, because of the rarity of CES, the sample size in this study was too small to provide definitive conclusions. Since no patients underwent surgery within 38.4 hours of symptoms, it is not possible to comment on the importance of emergent decompression in early presenters.

scholarly journals Sexual and Bladder Dysfunction in Cauda Equina Syndrome: Correlation with Clinical and Urodynamic Studies

2020 ◽  
Vol 14 (6) ◽  
pp. 782-789
Author(s):  
Gururaj Sangondimath ◽  
Abhinandan Reddy Mallepally ◽  
Amrithlal Mascharenhas ◽  
Harvinder Singh Chhabra
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Bladder Dysfunction ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Bladder Function ◽  
Leg Pain ◽  
Motor Weakness ◽  
Urodynamic Studies

Study Design: Retrospective cohort study.Purpose: To analyze the clinical and sphincteric outcomes and the extent of sexual dysfunction (SD) in subjects with cauda equina syndrome (CES) and to assess their correlation with patient-reported and clinical/urodynamic parameters.Overview of Literature: Despite vast literature present for CES, extent of the problem of SD in CES patients has not received enough attention as reflected by the limited information in literature. Little is known about exact prevalence at presentation or about the recovery. A better understanding of SD and bladder dysfunction in CES secondary to lumbar disc herniation is essential as it commonly occurs in the sexually active age group.Methods: All cases of cauda equine syndrome secondary to lumbar disc herniation were recruited. Biographical and clinical data, history, examination findings, operative variables, recovery, and SD were noted. Water cystometry and uroflowmetry were done pre- and postoperatively. The International Index of Erectile Function questionnaire and Female Sexual Function Index were used to assess SD among the men and women, respectively.Results: A total of 43 patients with up to 2.94-year follow-up were included. Urodynamic studies were found to correlate significantly with age, days of bladder involvement, perianal numbness, and motor weakness (<i>p</i><0.01). In step-wise regression analysis, perianal sensation and overall motor weakness were bladder function determinants. Bladder function recovery was directly related to the number of delay days (<i>t</i>=2.30, <i>p</i><0.05) and with unilateral leg pain (<i>t</i>=2.15, <i>p</i><0.05). Significant correlation between SD with age and days of bladder involvement before surgery was found (<i>p</i><0.01).Conclusions: Surgery timing is related to patient’s functional and sexual outcomes. Patients with unilateral leg pain and hypocontractile bladder have better outcomes. SD is a remarkable problem in CES.

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