Efficacy of delayed decompression of lumbar disk herniation causing cauda equina syndrome

Cauda equina syndrome (CES) is a rare but serious neurosurgical emergency that can have devastating long-lasting neurologic consequences. Compression of the cauda equina can result in paralysis of bowel and bladder function. Such compression has been considered the only absolute indication for surge...

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Bibliographic Details
Published in:	Orthopedics (Thorofare, N.J.) Vol. 37; no. 2; pp. e153 - e156
Main Authors:	Aly, Tarek A, Aboramadan, Mohamed Osama
Format:	Journal Article
Language:	English
Published:	United States SLACK INCORPORATED 01-02-2014
Subjects:	Adult Cauda Equina Syndrome Decompression, Surgical - methods Female Humans Intervertebral Disc Displacement - complications Intervertebral Disc Displacement - diagnosis Intervertebral Disc Displacement - surgery Male Middle Aged Polyradiculopathy - diagnosis Polyradiculopathy - etiology Polyradiculopathy - surgery Treatment Outcome
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Summary:	Cauda equina syndrome (CES) is a rare but serious neurosurgical emergency that can have devastating long-lasting neurologic consequences. Compression of the cauda equina can result in paralysis of bowel and bladder function. Such compression has been considered the only absolute indication for surgery in cases of lumbar disk disease. Therefore, it is extremely important that physicians be aware of the condition so that a surgeon is consulted before neurological damage becomes permanent. This article reports the results of delayed surgical decompression in cases of lumbar disk herniation with CES. The study group comprised 14 patients (11 men and 3 women) with a mean age of 48 years (range, 36-57 years). Clinical presentation was chronic low back pain, sciatica, and impaired sphincter function. All patients had a fenestration at the affected level and site, and the disk fragments were excised and the disk space cleared. The surgeries were performed 1 to 3 months after onset of sphinctric disturbance. Postoperatively, all patients were relieved of back and/or leg pain and showed sensory improvement. Twelve patients regained full control of urination and defecation. Lower extremity strength improved in 9 patients. The classical presentation of CES is not obvious. Even if surgery is performed late due to delayed presentation, significant improvement in neurologic and bladder function can still be expected.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0147-7447 1938-2367
DOI:	10.3928/01477447-20140124-18