Abstract

We aimed (1) to determine the factors which influence outcome after surgery for CES and (2) to study CES MRI measurements. 56 patients with evidence of a sphincteric disturbance who underwent urgent surgery (1994-2002) were identified and invited to clinic. 31 MRIs were available for analysis and randomised with 19 MRIs of patients undergoing discectomy for persistent radiculopathy. Observers estimated the percentage of spinal canal compromise and indicated whether they thought the scan findings could produce CES and whether the discs looked degenerate. Measurements were repeated after two weeks.

(1) 42 patients attended (mean follow up 60 months; range 25–114). Mean age at onset was 41 years (range 24–67). 26 patients were operated on within 48 hours of onset. Acute onset of sphincteric symptoms and the time to operation did not influence the outcomes. Leg weakness at onset persisted in a significant number at follow-up (p<0.005). Bowel disturbance at presentation was associated with sexual problems (<0.005) at follow-up. Urinary disturbance at presentation did not affect the outcomes. The 13 patients who failed their post-operative 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.

(2) No significant correlations were found between MRI canal compromise and clinical outcome. There was moderate to substantial agreement for intra- and inter-observer reproducibility.

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.

Objective: Determine factors influencing outcome after surgery for cauda equina syndrome with particular attention sphincteric recovery. Subjects:56 patients with evidence of a sphincteric disturbance who underwent urgent surgery between 1994 and 2002 were identified and invited for follow up.

Outcome Measures: History and examination, Oswestry Disability Index, Short Form 36, Visual Analogue Score, Low Back Outcome Score, Modified Somatic Perception Score, Modified Zung Depression Score, International Prostate Severity Score, Male Sexual Health Questionnaire and Sheffield Female Pelvic Floor Questionnaire.

Results: 42 patients attended with a mean follow up of 60 months (25 to 114 months). Mean age at onset was 41 years (24 to 67 years) with 23 males and 19 females. 25 patients had sudden onset of symptoms in less than 24 hours. 26 patients were operated on within 48 hours of onset. At presentation urinary retention was associated with acute onset of less than 24 hours (p0.01), leg weakness (p0.01), abnormal leg sensation (p0.05) and abnormal rectal tone (p0.05). Bilateral radiculopathy was associated with leg weakness (p0.005). All patients with abnormal rectal tone (21) had abnormal rectal sensation. At follow up significantly more females had urinary incontinence (p0.001) and bowel disturbance (p0.05), higher VAS scores (p0.05) and lower SF36 Pain and Energy scores (p0.05) than males. Urinary disturbance at presentation did not affect the outcomes. Bowel disturbance at presentation was associated with sexual problems (0.005) and abnormal rectal tone (p0.05) at follow up. Objective reduced perianal sensation at onset persisted in a significant number at follow up (21/32 patients; p0.05) as did leg weakness (14/23; p0.005). There was a weak association between delay to operation and bowel disturbance (p0.05) 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 (p0.05). 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.

Conclusions: 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. Patient counselling about this would therefore be appropriate.

Objective: To determine the factors which influence outcome after surgery for cauda equina syndrome. Particular attention has been given to sphincteric recovery.

Study Design: Retrospective cohort study with prospective clinical follow up.

Subjects: 56 patients with evidence of a sphincteric disturbance who underwent urgent surgery between 1994 and 2002 were identified and invited for follow up.

Outcome Measures: History and examination, Oswestry Disability Index, Short Form 36 Health Survey Questionnaire, Visual Analogue Score, Low Back Outcome Score, Modified Somatic Perception Score, Modified Zung Depression Score, International Prostate Severity Score, Male Sexual Health Questionnaire and Sheffield Female Pelvic Floor Questionnaire.

Results: 42 patients attended with a mean follow up of 60 months (Range 25–114 months). Mean age at onset was 41 years (Range 24–67 years) with 23 males and 19 females. 25 patients had sudden onset of symptoms in less than 24 hours. 26 patients were operated on within 48 hours of onset. At presentation urinary retention was associated with acute onset of less than 24 hours (p< 0.01), leg weakness (p< 0.01), abnormal leg sensation (p< 0.05) and abnormal rectal tone (p< 0.05). Bilateral radiculopathy was associated with leg weakness (p< 0.005). All patients with abnormal rectal tone (21) had abnormal rectal sensation.

At follow up significantly more females had urinary incontinence (p< 0.001) and bowel disturbance (p< 0.05), higher VAS scores (p< 0.05) and lower SF36 Pain and Energy scores (p< 0.05) than males. 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. Objective reduced perianal sensation at onset persisted in a significant number at follow up (21/32 patients; p< 0.05) as did leg weakness (14/23; p< 0.005). 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 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.

Conclusions: 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. Patient counselling about this would therefore be appropriate.