Cauda equina syndrome (CES) from lumbar disc herniations

William C. Olivero, Huan Wang, William C. Hanigan, John P. Henderson, Patrick T. Tracy, Patrick W. Elwood, J. Richard Lister, Lynne Lyle

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN: A retrospective review was performed to determine the outcomes of patients with cauda equina syndrome (CES) from a herniated lumbar disc at our institutions. OBJECTIVE: CES from lumbar herniated discs is considered the only absolute indication for surgery. It is considered a neurosurgical emergency with the outcome related to how quickly it is diagnosed and treated. The results of recovery of bladder function are felt by many authors to be related to early diagnosis and surgical intervention. Most authors recommend a wide decompressive laminectomy when surgery is performed. We reviewed our cases to determine if they conformed to these assumptions. SUMMARY OF BACKGROUND DATA: Although many articles regarding the outcome of CES from herniated lumbar discs suggest that early surgery is superior to surgery that is delayed, others have demonstrated no correlation between time-to-surgery and chances for recovery of neurologic and bladder function. METHODS: A retrospective review of all patients with lumbar herniated discs and CES from the years 1985 to 2004 was carried out. There were 31 patients, 28 of whom had bladder incontinence or retention requiring catheterization. Six patients were operated within 24 hours, 8 between 24 and 48 hours, and 17 after 48 hours (range: 60 h to 2 wk). Average follow-up was 5 years. RESULTS: Twenty-seven of these patients regained continence not requiring catheterization. There was no correlation between the time-to-surgery and recovery of bladder function. There was also no correlation between the time-to-surgery and recovery of motor and sensory function. The majority of patients underwent unilateral hemilaminotomy or bilateral hemilaminotomies; decompressive laminectomy was reserved for patients with underlying spinal stenosis or posteriorly herniated fragments. All of the patients were relieved of their radicular pain. CONCLUSIONS: In our series of patients with CES and bladder incontinence or retention, over 90% regained continence. Recovery of function was not related to the time to surgical intervention. The majority of the patients were adequately treated without the need for a complete laminectomy.

Original languageEnglish (US)
Pages (from-to)202-206
Number of pages5
JournalJournal of Spinal Disorders and Techniques
Volume22
Issue number3
DOIs
StatePublished - May 1 2009

Fingerprint

Polyradiculopathy
Intervertebral Disc Displacement
Recovery of Function
Urinary Bladder
Laminectomy
Catheterization
Spinal Stenosis
Nervous System
Early Diagnosis
Emergencies

Keywords

  • Bladder incontinence
  • Cauda equina syndrome
  • Lumbar disc herniation

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Olivero, W. C., Wang, H., Hanigan, W. C., Henderson, J. P., Tracy, P. T., Elwood, P. W., ... Lyle, L. (2009). Cauda equina syndrome (CES) from lumbar disc herniations. Journal of Spinal Disorders and Techniques, 22(3), 202-206. https://doi.org/10.1097/BSD.0b013e31817baad8

Cauda equina syndrome (CES) from lumbar disc herniations. / Olivero, William C.; Wang, Huan; Hanigan, William C.; Henderson, John P.; Tracy, Patrick T.; Elwood, Patrick W.; Lister, J. Richard; Lyle, Lynne.

In: Journal of Spinal Disorders and Techniques, Vol. 22, No. 3, 01.05.2009, p. 202-206.

Research output: Contribution to journalArticle

Olivero, WC, Wang, H, Hanigan, WC, Henderson, JP, Tracy, PT, Elwood, PW, Lister, JR & Lyle, L 2009, 'Cauda equina syndrome (CES) from lumbar disc herniations', Journal of Spinal Disorders and Techniques, vol. 22, no. 3, pp. 202-206. https://doi.org/10.1097/BSD.0b013e31817baad8
Olivero WC, Wang H, Hanigan WC, Henderson JP, Tracy PT, Elwood PW et al. Cauda equina syndrome (CES) from lumbar disc herniations. Journal of Spinal Disorders and Techniques. 2009 May 1;22(3):202-206. https://doi.org/10.1097/BSD.0b013e31817baad8
Olivero, William C. ; Wang, Huan ; Hanigan, William C. ; Henderson, John P. ; Tracy, Patrick T. ; Elwood, Patrick W. ; Lister, J. Richard ; Lyle, Lynne. / Cauda equina syndrome (CES) from lumbar disc herniations. In: Journal of Spinal Disorders and Techniques. 2009 ; Vol. 22, No. 3. pp. 202-206.
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