Asian Spine Journal

Korean Society of Spine Surgery (대한척추외과학회)
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Bladder Recovery Patterns in Patients with Complete Cauda Equina Syndrome: A Single-Center Study

  • Received : 2018.02.28
  • Accepted : 2018.04.21
  • Published : 2018.12.31
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Abstract

Study Design: Retrospective case series. Purpose: Cauda equina syndrome (CES) is associated with etiologies such as lumbar disc herniation (LDH) and lumbar canal stenosis (LCS). CES has a prevalence of 2% among patients with LDH and exhibits variable outcomes, even with early surgery. Few studies have explored the factors influencing the prognosis in terms of bladder function. Therefore, we aimed to assess the factors contributing to bladder recovery and propose a simplified bladder recovery classification. Overview of Literature: Few reports have described the prognostic clinical factors for bladder recovery following CES. Moreover, limited data are available regarding a meaningful bladder recovery status classification useful in clinical settings. Methods: A single-center retrospective study was conducted (April 2012 to April 2015). Patients with CES secondary to LDH or LCS were included. The retrieved data were evaluated for variables such as demographics, symptom duration, neurological symptoms, bladder symptoms, and surgery duration. The variable bladder function outcome during discharge and at follow-up was recorded. All subjects were followed up for at least 2 years. A simplified bladder recovery classification was proposed. Statistical analyses were performed to study the correlation between patient variables and bladder function outcome. Results: Overall, 39 patients were included in the study. Majority of the subjects were males (79.8%) with an average age of 44.4 years. CES secondary to LDH was most commonly seen (89.7%). Perianal sensation (PAS) showed a significant correlation with neurological recovery. In the absence of PAS, bladder function did not recover. Voluntary anal contraction (VAC) was affected in all study subjects. Conclusions: Intactness of PAS was the only significant prognostic variable. Decreased or absent VAC was the most sensitive diagnostic marker of CES. We also proposed a simplified bladder recovery classification for recovery prognosis.

Keywords

References

  1. Fraser S, Roberts L, Murphy E. Cauda equina syndrome: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil 2009;90:1964-8. https://doi.org/10.1016/j.apmr.2009.03.021
  2. Gleave JR, Macfarlane R. Cauda equina syndrome: what is the relationship between timing of surgery and outcome? Br J Neurosurg 2002;16:325-8. https://doi.org/10.1080/0268869021000032887
  3. Korse NS, Jacobs WC, Elzevier HW, Vleggeert-Lankamp CL. Complaints of micturition, defecation and sexual function in cauda equina syndrome due to lumbar disk herniation: a systematic review. Eur Spine J 2013;22:1019-29. https://doi.org/10.1007/s00586-012-2601-8
  4. Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine (Phila Pa 1976) 2000;25:1515-22. https://doi.org/10.1097/00007632-200006150-00010
  5. Gardner A, Gardner E, Morley T. Cauda equina syndrome: a review of the current clinical and medicolegal position. Eur Spine J 2011;20:690-7. https://doi.org/10.1007/s00586-010-1668-3
  6. Kelly CE. Evaluation of voiding dysfunction and measurement of bladder volume. Rev Urol 2004;6 Suppl 1:S32-7.
  7. Balasubramanian K, Kalsi P, Greenough CG, Kuskoor Seetharam MP. Reliability of clinical assessment in diagnosing cauda equina syndrome. Br J Neurosurg 2010;24:383-6. https://doi.org/10.3109/02688697.2010.505987
  8. Ahad A, Elsayed M, Tohid H. The accuracy of clinical symptoms in detecting cauda equina syndrome in patients undergoing acute MRI of the spine. Neuroradiol J 2015;28:438-42. https://doi.org/10.1177/1971400915598074
  9. Gooding BW, Higgins MA, Calthorpe DA. Does rectal examination have any value in the clinical diagnosis of cauda equina syndrome? Br J Neurosurg 2013;27:156-9. https://doi.org/10.3109/02688697.2012.732715
  10. Beculic H, Skomorac R, Jusic A, et al. Impact of timing on surgical outcome in patients with cauda equina syndrome caused by lumbar disc herniation. Med Glas (Zenica) 2016;13:136-41.
  11. Korse NS, Pijpers JA, van Zwet E, Elzevier HW, Vleggeert-Lankamp CLA. Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction. Eur Spine J 2017;26:894-904. https://doi.org/10.1007/s00586-017-4943-8
  12. Ma B, Wu H, Jia LS, Yuan W, Shi GD, Shi JG. Cauda equina syndrome: a review of clinical progress. Chin Med J (Engl) 2009;122:1214-22.
  13. Cohen SP, Argoff CE, Carragee EJ. Management of low back pain. BMJ 2008;337:a2718. https://doi.org/10.1136/bmj.a2718