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. 2008 Apr;8(4):305-20.
doi: 10.3171/SPI/2008/8/4/305.

Timing of Surgery in Cauda Equina Syndrome With Urinary Retention: Meta-Analysis of Observational Studies


Timing of Surgery in Cauda Equina Syndrome With Urinary Retention: Meta-Analysis of Observational Studies

W Bradford DeLong et al. J Neurosurg Spine. .


Object: The authors performed exploratory meta-analyses of observational cohort studies, evidence level III, examining whether earlier surgery makes a difference in outcome in terms of urinary function once cauda equina syndrome (CES) from a herniated lumbar disc has progressed to urinary retention (CESR).

Methods: Literature search identified 27 studies of CESR patients with clear definition of surgical timing. Relative risk (RR) could not be calculated in 11 studies, leaving 16 for meta-analysis. Urinary retention related to surgical timing at 5 breakpoints: 12, 24, 36, 48, or 72 hours. Urinary outcome was classified as Normal, Fair, or Poor. Meta-analysis was performed for "Event = Fair/Poor" or "Event = Poor." Eight studies allowed separation into CESR and incomplete CES (CESI), and 5 of these had enough data for meta-analysis to compare CESR and CESI. A random effects meta-analysis model was used because of heterogeneity across the studies. A best-evidence synthesis was performed for the 4 largest studies that had 24- and 48-hour breakpoints.

Results: For "Event = Fair/Poor," meta-analyses using the 5 breakpoints predicted a more likely Fair/Poor outcome for later surgery (RR range 1.77-2.19). The RR for later timing of surgery was statistically significant for 24-and 72-hour breakpoints and was elevated but not statistically significant for the other 3. For "Event = Poor," the RR range was 1.09-5.82, statistically significant for the 36 hour breakpoint only. Meta-analysis comparing CESR patients with CESI patients predicted a Fair/Poor result for CESR (RR 2.58, 95% confidence interval 0.59-11.31). The best-evidence synthesis did not disclose reasons for differences in the results of the 4 studies.

Conclusions: This study supports early surgery for CES and indicates that CESR and CESI cases should not be analyzed together.

Comment in

  • Cauda equina syndrome.
    Findlay G, Macfarlane R. Findlay G, et al. J Neurosurg Spine. 2009 Jul;11(1):90-1; author reply 91-2. doi: 10.3171/2009.2.SPINE08673L. J Neurosurg Spine. 2009. PMID: 19569949 No abstract available.

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