Factors influencing the outcome in patients with cauda equina syndrome

Česká verze

Authors: D. Měšťan ¹; B. Musilová ¹; O. Teplý ¹; A. Lisner ²; J. Fiedler ^1,3
Authors place of work: Neurochirurgické oddělení, Nemocnice České Budějovice, a. s. ¹; Katedra botaniky, Přírodovědecká fakulta, Jihočeská univerzita v Českých Budějovicích ²; Neurochirurgická klinika LF MU a FN Brno ³
Published in the journal: Cesk Slov Neurol N 2024; 87(2): 139-143
Category: Krátké sdělení
doi: https://doi.org/10.48095/cccsnn2024139

Summary

Cauda equina syndrome (CES) is a severe neurological condition with potentially high morbidity. Patients usually present with varying degrees of neurological deficit, especially sphincter dysfunction, which needs to be diagnosed early and correctly indicated for surgical treatment. Our retrospective study is focused on the determination of different prognostic factors and their impact on the final neurological outcome of patients with CES. Forty-four CES patients were recruited in the study. The duration of symptoms has proven to be a statistically significant factor in improving the clinical condition. Patients with a shorter medical history of neurological symptomatology had a better neurological outcome. Also, there was a positive relationship between the initial and outcome score, i.e., the outcome status is related to the severity of the neurological deficit on admission. The remaining factors appeared to be statistically insignificant.

Keywords:

prognostic factors – urinary retention – cauda equina – cauda equina syndrome

Zdroje

1. Hazelwood JE, Hoeritzauer I, Pronin S et al. An assessment of patient-reported long-term outcome following surgery for cauda equina syndrome. Acta Neurochir (Wien) 2019; 161 (9): 1887–1894. doi: 10.1007/s00701-019-03973-7.

2. Heyes G, Jones M, Verzin E et al. Influence of timing of surgery on cauda equina syndrome: outcomes at a national spine centre. J Orthop 2018; 15 (1): 210–215. doi: 10.1016/j.jor.2018.01.020.

3. Long B, Koyfman A, Gottlieb M et al. Evaluation and management of cauda equina syndrome in the emergency department. Am J Emerg Med 2019; 38 (1): 143–148. doi: 10.1016/j.ajem.2019.158402.

4. Bydon M, Gokaslan Z. Time to treatment of cauda equina syndrome: a time to re-evaluate our clinical decision. World Neurosurg 2014; 82 (3–4): 344–345. doi: 10.1016/j.wneu.2014.03.006.

5. Chau AMT, Xu LL, Pelzer et al. Timing of surgical intervention in cauda equina syndrome: a systematic critical review. World Neurosurg 2014; 81 (3–4): 640–650. doi: 10.1016/j.wneu.2013.11.007.

6. Nater A, Fehlings MG. The timing of decompressive spinal surgery in cauda equina syndrome: a perspective statement. World Neurosurgery 2015; 83 (1): 19–22. doi: 10.1016/j.wneu.2014.03.017.

7. Lavy C, Marks P, Dangas K et al. Cauda equina syndrome – a practical guide to definition and classification. Int Ortop 2022; 46 (2): 165–169. doi: 10.1007/s00264-021-05273-1.

8. Yang JY, Lee JK, Song HS et al. Clinical outcome based cauda equina syndrom scoring system for prediction of prognosis. J Korean Soc Spine Surf 2011; 18 (2): 57–63. doi: 10.4184/jkss.2011.18.2.57.

9. Core Team (2022). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available from: https: //www. R-project.org.

10. Wickham H. ggplot2: elegant graphics for data analysis. New York: Springer – Verlag 2016.

11. Kuris EO, McDonalds CL, Palumbo MA et al. Evaluation and management of cauda equina syndrome. Am J Med 2021; 134 (12): 1483–1489. doi: 10.1016/j.amjmed.2021.07.021.

12. Grasso G, Munakomi S, Salli M. Red flag for cauda equina syndrome in symptomatic lumbar disc herniation. World Neurosurg 2020; 143: 232–234. doi: 10.1016/j.wneu.2020.07.200.

13. Kaiser R, Krajcová A, Waldauf P et al. Are There any risk factors associated with the presence of cauda equina syndrome in symptomatic lumbar disk herniaton? World Neurosurg 2020; 141: e600–e605. doi: 10.1016/ j.wneu.2020.05.260.

14. Katzouraki G, Zubairi AJ, Hershovich O et al. A prospective study of the role of bladder scanning and post-void residual volume measurement in improving diagnostic accuracy of cauda equina syndrome. Bone Joint J 2020; 102-B (6): 677–682. doi: 10.1016/j.wneu.2020.07.200.

15. Todd NV. Guidelines for cauda equina syndrome. Red flags and white flags. Systematic review and implications for triage. Br J Neurosurg 2017; 31 (3): 336–339. doi: 10.1080/02688697.2017.1297364.

16. Demetriades A. Cauda equina syndrome – from timely treatment to the timing of out-of-hours surgery. Acta Neurochir (Wien) 2022; 164 (5): 1201–1202. doi: 10.1007/s00701-022-05174-1.

17. Bydon M, Lin JA, Garza-Ramos R et al. Time to surgery and outcomes in cauda equina syndrome: an analysis of 45 cases. World Neurosurg 2016; 87: 110–115. doi: 10.1016/j.wneu.2015.12.054.

18. Korse NS, Pijpers JA, Zwet E tel a. Cauda equina syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction. Eur Spine J 2016; 26 (3): 894–904. doi: 10.1007/s00586-017-4943-8.

19. Lam J, de Souza RM, Layock J et al. Patient-reported bladder, bowel and sexual function after cauda equina syndrome secondary to a herniated lumbar intervertebral disc. Top Spinal Cord Inj Rehabil 2020; 26 (4): 290–303. doi: 10.46292/sci19-00065.

20. Hogen WB, Kuris EO, Wesley MD et al. Timing of surgical decompression for cauda equina syndrome. World Neurosurg 2019; 132: e732–e738. doi: 10.1016/ j.wneu.2019.08.030.

21. Mirza A, Velicu MA, Lyon R et al. Is cauda equina surgery safe out-of-hours? A single United Kingdom institute experience. World Neurosurg 2022; 159: e208–e220. doi: 10.1016/j.wneu.2021.12.028.

22. Francis JJ, Goacher E, Fuge J et al. Lumbar decompression surgery for cauda equina syndrome – comparison of complication rates between daytime and overnight operating. Acta Neurochir (Wien) 2022; 164 (5): 1203–1208. doi: 10.1007/s00701-022-05 173-2.