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Inicio Revista Española de Cirugía Ortopédica y Traumatología (English Edition) Cauda equina syndrome secondary to lumbar disc herniation: Surgical delay and it...
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Vol. 60. Issue 3.
Pages 153-159 (May - June 2016)
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Vol. 60. Issue 3.
Pages 153-159 (May - June 2016)
Original Article
DOI: 10.1016/j.recote.2016.01.007
Cauda equina syndrome secondary to lumbar disc herniation: Surgical delay and its relationship with prognosis
Síndrome de cauda equina por hernia discal lumbar: demora quirúrgica y su relación con el pronóstico
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X. Foruriaa,
Corresponding author
Xabierforuria@hotmail.com

Corresponding author.
, K. Ruiz de Gopeguia, I. García-Sáncheza, J. Moretaa, U. Aguirreb, J.L. Martínez-de los Mozosa
a Servicio de Cirugía Ortopédica y Traumatología, Hospital Galdakao-Usansolo, Galdakao, Spain
b Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Spain
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Tables (3)
Table 1. Description of the series studied.
Table 2. Motor recovery in relation to the factors studied.
Table 3. Analysis in subgroups for motor and sphincter function recovery taking surgical delay time into account and the presence of complete or incomplete CES at the start of symptoms.
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Abstract
Objective

To determine whether surgical treatment delayed for more than 48h in patients with cauda equina syndrome (CES) influenced the clinical outcome.

Material and methods

A retrospective study of 18 patients treated in our hospital from March 2000 to January 2012, after presenting with CES. The pre- and post-operative clinical status was determined: existence of back pain and/or sciatica, sensory disturbance in the perineum, sensory and motor deficits in the lower extremities, and the degree of sphincter incontinence (complete or incomplete CES). A clinical assessment was performed using the Oswestry disability index.

Results

As regards the onset of symptoms, 44% (8 of 18) of patients were treated at an early stage (within 48h). None of the patients with complete CES operated in the early stage had urinary incontinence, and also had greater motor recovery. Of the 5 patients with complete CES who underwent delayed surgery, 3 showed residual urinary incontinence. A mean of 12.55 was obtained on the Oswestry disability index scale at the end of follow-up.

Conclusion

Although no statistically significant difference was found in our study, we observed greater motor and sphincter recovery in patients who were operated on within 48h.

Keywords:
Cauda equina syndrome
Lumbar disc herniation
Sphincter disturbance
Resumen
Objetivo

Constatar si la demora en más de 48h en el tratamiento quirúrgico de los pacientes con síndrome de cauda equina (SCE) influyó en el resultado clínico de nuestros pacientes.

Material y métodos

Estudio retrospectivo de 18 pacientes intervenidos en nuestro centro desde marzo de 2000 a enero de 2012, tras presentar SCE. Se recogió la situación clínica pre- y postoperatoria: existencia de dolor lumbar y/o ciático, alteración sensitiva en periné, déficit motor y sensitivo en extremidades inferiores y el grado de incontinencia esfinteriana (SCE completo o incompleto). Se realizó una valoración mediante el índice de discapacidad de Oswestry.

Resultados

Teniendo en cuenta el inicio de los síntomas, el 44% (8 de 18) de los pacientes se intervinieron de forma precoz (menos de 48h). Ninguno de los pacientes con SCE completo intervenidos precozmente tuvieron incontinencia urinaria residual, presentando además mayor grado de recuperación motora. De los 5 pacientes con SCE completo intervenidos de forma tardía (más de 48h), 3 continuaron con incontinencia urinaria residual. Al final del seguimiento se obtuvo una media de 12,55 en las escala de discapacidad de Oswestry.

Conclusión

Aunque no se han encontrado diferencias estadísticamente significativas, en nuestra serie hemos observado mayor recuperación motora y esfinteriana en los pacientes que fueron intervenidos antes de las 48h.

Palabras clave:
Síndrome de cauda equina
Hernia discal lumbar
Disfunción esfinteriana

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