Medical realities of cauda equina syndrome secondary to lumbar disc herniation

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.