Medical realities of cauda equina syndrome secondary to lumbar disc herniation

Spine (Phila Pa 1976). 2000 Feb 1;25(3):348-51; discussion 352. doi: 10.1097/00007632-200002010-00015.


Study design: An analysis of 44 cauda equina syndrome cases.

Objectives: To determine the neurologic outcome of cauda equina syndrome cases, in light of the significant medical implications of this disorder.

Summary of background data: Cauda equina syndrome from lumbar disc herniation accounts for up to 1% of all disc herniations. Most of the literature supports surgery within 24 hours as a means of improving the outcome.

Methods: A retrospective chi 2 analysis was performed of 44 patients surgically treated for lumbar disc herniation who initially sought treatment for cauda equina syndrome.

Results: In 20 patients, diagnosis was made and surgery performed within 48 hours of the cauda equina syndrome onset, including 18 patients (90%) who underwent surgery within 24 hours. In 24 patients, surgery was performed more than 48 hours after the onset of cauda equina syndrome, with a mean delay of 9 days, including 17 patients (71%) with a mean delay of 3.7 days. Causes for delay were patient-related in 4 cases (17%) and physician-related in 20 cases (83%). According to chi 2 analysis, a greater chance of persistent bladder/sphincter problem (P = 0.008), persistent severe motor deficit (P = 0.006), persistent pain (P = 0.025), and sexual dysfunction (P = 0.006) existed with delayed surgery.

Conclusion: The data strongly support the management of cauda equina syndrome from lumbar disc herniation as a diagnostic and surgical emergency.

MeSH terms

  • Adult
  • Aged
  • Emergencies
  • Female
  • Humans
  • Intervertebral Disc Displacement / complications*
  • Intervertebral Disc Displacement / diagnostic imaging
  • Intervertebral Disc Displacement / surgery
  • Lumbar Vertebrae*
  • Male
  • Middle Aged
  • Polyradiculopathy / diagnostic imaging
  • Polyradiculopathy / etiology*
  • Polyradiculopathy / physiopathology
  • Polyradiculopathy / surgery
  • Radiography
  • Retrospective Studies
  • Sexual Behavior
  • Time Factors