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Vol. 30. Issue 6.
Pages 278-287 (November - December 2019)
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Vol. 30. Issue 6.
Pages 278-287 (November - December 2019)
Clinical Research
DOI: 10.1016/j.neucie.2019.05.002
Cauda equina syndrome due to disk herniation: Long-term functional prognosis
Síndrome de cola de caballo por hernia discal: pronóstico funcional a largo plazo
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Pedro David Delgado-López
Corresponding author
pedrodl@yahoo.com

Corresponding author.
, Javier Martín-Alonso, Vicente Martín-Velasco, José Manuel Castilla-Díez, Ana Galacho-Harriero, Sara Ortega-Cubero, Antonio Rodríguez-Salazar
Servicio de Neurocirugía, Hospital Universitario de Burgos, Spain
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Tables (6)
Table 1. Signs and symptoms related to CES categorized in incomplete CES (CESI) and complete CES with urinary retention (CESR), according to the definition by Gleave and McFarlane.4
Table 2. Clinical features of the cohort of patients presenting CES due to lumbar disk herniation (BL: bilateral laminectomy).
Table 3. Time intervals, from the onset of symptoms to diagnosis and to surgery, in the CES cohort.
Table 4. Outcome at the end of follow up compared to preoperative status in the CESR Group.
Table 5. Outcome at the end of follow up compared to preoperative status in the CESI group.
Table 6. Final outcome according to the timing of surgery (before or after 48h from the onset of symptoms). Sphincter recovery includes patients with partial or complete urinary and anal sphincter recovery.
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Abstract
Objective

Cauda equina syndrome (CES) caused by lumbar disk extrusion is classically considered an indication of urgent surgery. CES can be subdivided into CESI (incomplete CES) and CESR (complete CES with urinary retention and incontinence). This paper evaluates the long-term functional outcome of a CES cohort operated on due to disk herniation.

Methods

Single-center retrospective observational study. CES patients due to disk herniation that underwent surgery between 2000 and 2016 were included in the study. Demographic data, time intervals to diagnosis and surgery, preoperative neurologic status and outcome at the end of follow up were recorded.

Results

Twenty-two patients were included (median age 44 years). Eight patients were CESR and 14 CESI. Median time from symptom onset to diagnosis was 78h (range, 12–720h), and from diagnosis to surgery 24h (range, 5–120h). Median follow up was 75 months (range, 20–195 months). At the end of follow up, in the CESR group (median time from diagnosis to surgery, 23h) only pain significantly improved after surgery (p=0.007). In the CESI group (median time from diagnosis to surgery 23h) low back pain, sciatica and urinary sphincter function significantly improved (p<0.001). There were no significant differences between early (<48h) operation (n=4) and late (n=18) in terms of sphincter recovery (Fisher's Exact Test, p=0.076).

Conclusion

Pain associated to CES improved both in the CESI and CESR groups. However, urinary sphincter impairment significantly improved only in the CESI group. No significant differences were found regarding long-term functional outcome between early and late surgery.

Keywords:
Cauda equina syndrome
Disk herniation
Laminectomy
Sphincter
Prognosis
Resumen
Objetivo

El síndrome de cola de caballo (SCC) producido por extrusión discal se ha considerado clásicamente una urgencia neuroquirúrgica. El SCC puede dividirse en SCC-I (incompleto) y en SCC-C (completo, con retención urinaria e incontinencia). Este trabajo evalúa el pronóstico funcional a largo plazo de una cohorte de pacientes con SCC por hernia discal intervenidos.

Material y métodos

Estudio observacional retrospectivo unicéntrico. Se incluyeron todos los pacientes diagnosticados de SCC por hernia discal e intervenidos en el período 2000-2016. Se recogieron datos demográficos, intervalos de tiempo entre el inicio de síntomas, el diagnóstico y la cirugía, y estado neurológico preoperatorio y al final del seguimiento.

Resultados

Se incluyeron un total de 22 pacientes (edad mediana de 44 años). Ocho casos fueron SCC-C y 14 SCC-I. El tiempo medio desde el inicio de los síntomas hasta el diagnóstico fue de 78h (rango, 12-720h), y desde el diagnóstico hasta la cirugía de 24h (rango, 5-120h). El seguimiento mediano fue de 75 meses (rango, 20-195). Al final del seguimiento, en el grupo SCC-C (tiempo medio desde diagnóstico hasta la cirugía, 23h) sólo el dolor mejoró de forma significativa tras la cirugía (p = 0,007). En el grupo SCC-I (tiempo medio desde diagnóstico hasta la cirugía, 23h) mejoraron significativamente el dolor lumbar, la ciática y el control del esfínter urinario (p < 0.01). No se constataron diferencias significativas entre los operados precozmente (antes de 48h, n = 4) y tardíamente (n = 18) en relación a la recuperación esfinteriana (Test exacto de Fisher, p = 0,076).

Conclusión

El dolor asociado al SCC mejoró tanto en los casos completos como incompletos. Sin embargo, el control del esfínter urinario sólo mejoró significativamente en los pacientes con síndromes incompletos. No se encontraron diferencias significativas en cuanto al resultado funcional a largo plazo entre intervenidos precoz y tardíamente.

Palabras clave:
Síndrome de cola de caballo
Hernia discal
Laminectomía
Esfínter
Pronóstico

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