Long term clinical outcome following decompressive surgery for Cauda Equina Syndrome

Study design: Retrospective study with prospective long-term clinical follow-up. Background: Cauda equina syndrome (CES) is a neurosurgical emergency, mostly caused by herniated lumbar disc for which urgent surgical decompression is indicated. Data on long-term clinical outcome of bladder, bowel & sexual function following decompression are elusive. Aim: To evaluate the effectiveness of surgical decompression on recovery of CES symptoms at long-term follow-up & role of timing of surgery on the outcome. Methods: Records of 35 CES patients who underwent surgical decompression for herniated lumbar disc during a five years period retrospectively analysed & patients called for follow-up visits. Outcome measures comprised of history & clinical examination pertinent to bladder, bowel & sexual function. Results: Twenty-four patients (68.5%) were included for final evaluation who attended follow-up visits, with a minimum follow-up period of one year. Most common complaint at presentation was bladder dysfunction (100%) with urinary retention in 16 patients (66.6%), faecal incontinence in 11 (45.8%), saddle anaesthesia in 22 (91.6%) & erectile dysfunction in 6 patients (out of 15 males). Only four patients underwent surgery within 48 hours of CES symptom onset, rest cases after 48 hours duration. At follow-up, bladder dysfunction present in 33.3% with urinary retention in 16.6%. Faecal incontinence persisted in 4 patients (16.6%) & saddle anaesthesia in 7 (29.1%). Sexual dysfunction was the most persistent complaint. Conclusion: Long-term follow-up shows significant recovery of sphincteric function in CES patients after surgical decompression. Urinary & bowel dysfunction improve significantly. Timing to surgery didn’t affect the long-term outcome.