TRAUMATIC CAUDA EQUINA: THE ROLE OF SURGICAL DECOMPRESSION AND RECOVERY OF NEUROLOGICAL FUNCTION.

Abstract

Introduction: Traumatic cauda equina constitutes a significant number of presentations of spinal cord injury in the emergency setting. Cauda equina syndrome from lumbar disc herniation accounts for up to 2–3% of all disc herniation. The aim of this study was to investigate and compare the success of surgical intervention between cauda equina that results from acute versus chronic pathology.

Patients and Methods: 47 patients who underwent surgery for cauda equina syndrome due to acute trauma or a herniated disc in the period between 2000 and 2006. All presented with one or more of the categorical symptoms associated with cauda equina (CE) syndrome such as sciatica, saddle hypoaesthesia, urinary incontinence and others. All patients had been catheterised at the time of admission to the National Spinal Unit. Patients presenting with acute CE underwent surgery within 24 hours. Patients presenting with chronic pathology underwent surgery within 48 hours. Differences in postoperative resolution of neurological function is compared between the two groups. The role of preoperative duration of symptoms in recovery of bladder function was examined.

Results: The follow-up ranged from 12–86 months. In 33 patients (70%) excellent results were achieved, in 8 patients (18%) good results were achieved and in 6 patients (10%) poor results were achieved. There was no statistically significant difference concerning the time between the onset of symptoms and surgical decompression. Significant difference appears to exist between the neurological recovery of those patients who underwent surgery subsequent to acute trauma in comparison to those with longer standing pathology.

Conclusion: Surgical intervention results in the resolution of neurological symptoms in those patients who present with symptoms consistent with cauda equina. This result is more apparent in those who presented with acute trauma.