Long-term core outcomes in cauda equina syndrome

Bone Joint J. 2021 Sep;103-B(9):1464-1471. doi: 10.1302/0301-620X.103B9.BJJ-2021-0094.R1.


Aims: Cauda equina syndrome (CES) can be associated with chronic severe lower back pain and long-term autonomic dysfunction. This study assesses the recently defined core outcome set for CES in a cohort of patients using validated questionnaires.

Methods: Between January 2005 and December 2019, 82 patients underwent surgical decompression for acute CES secondary to massive lumbar disc prolapse at our hospital. After review of their records, patients were included if they presented with the clinical and radiological features of CES, then classified as CES incomplete (CESI) or with painless urinary retention (CESR) in accordance with guidelines published by the British Association of Spinal Surgeons. Patients provided written consent and completed a series of questionnaires.

Results: In total, 61 of 82 patients returned a completed survey. Their mean age at presentation was 43 years (20 to 77; SD 12.7), and the mean duration of follow-up 58.2 months (11 to 182; SD 45.3). Autonomic dysfunction was frequent: 33% of patients reported bladder dysfunction, and 10% required a urinary catheter. There was a 38% and 53% incidence of bowel and sexual dysfunction, respectively: 47% of patients reported genital numbness. A total of 67% reported significant back pain: 44% required further investigation and 10% further intervention for the management of lower back pain. Quality of life was lower than expected when corrected for age and sex. Half the patients reported moderate or worse depression, and 40% of patients of working age could no longer work due to problems attributable to CES. Urinary and faecal incontinence, catheter use, sexual dysfunction, and genital numbness were significantly more common in patients with CESR.

Conclusion: This study reports the long-term outcome of patients with CES and is the first to use validated patient-reported outcome measures to assess the CES Core Outcome Set. Persistent severe back pain and on-going autonomic dysfunction were frequently reported at a mean follow-up of five years. Cite this article: Bone Joint J 2021;103-B(9):1464-1471.

Keywords: Autonomic dysfunction; Cauda equina syndrome; Cauda equina syndrome (CES); Core outcomes; Long-term outcomes; Low back pain; Lumbar disc prolapse; Spinal Surgeons; back and leg pain; bladder; catheter; depression; lower back pain; patient-reported outcome measures; surgical decompression.

MeSH terms

  • Adult
  • Autonomic Nervous System Diseases / epidemiology*
  • Cauda Equina Syndrome / surgery*
  • Decompression, Surgical
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Postoperative Complications / epidemiology*
  • Prognosis
  • Retrospective Studies
  • Time-to-Treatment