CAUDA EQUINA SYNDROME: FACTORS AFFECTING THE OUTCOME OF 42 PATIENTS WITH A MEAN FOLLOW UP OF 5 YEARS

Abstract

Introduction: To determine the factors which influence outcome after surgery for cauda equina syndrome.

Method: 56 patients with evidence of sphincteric disturbance who underwent urgent surgery between 1994 and 2002 were identified and invited to follow up. Outcomes consisted of history and examination, and several validated questionnaires.

Results: 42 patients attended with a mean follow up of 60 months (range 25–114). Mean age at onset was 41 years (range 24–67) with 23 males and 19 females. 26 patients were operated on within 48 hours of onset. Urinary disturbance at presentation did not affect the outcomes. Bowel disturbance at presentation was associated with sexual problems (< 0.005) and abnormal rectal tone (p< 0.05) at follow up. There was a weak association between delay to operation and bowel disturbance (p< 0.05) at follow up. Eight patients had faecal soiling and faecal incontinence at follow up and this was associated with sudden onset of symptoms, initial abnormal rectal tone and time to operation (p< 0.05). The 12 patients who failed their postoperative trial without catheter had worse outcomes. The SF36 scores at follow up were reduced compared to age matched norms in the population. The mean ODI was 29, LBOS 42 and VAS 4.5.

Discussion: In our series the duration of symptoms and speed of onset prior to surgery appears to influence bowel but not bladder outcome two years after surgery. Based on the SF36, LBOS and ODI scores, patients who have had CES do not return to a normal status.