Treatment and outcome of Cauda equina syndrome secondary to herniated disc: Thirty-year evolution

Objective Cauda equina syndrome (CES) is an uncommon neurological condition caused by compression of the Cauda equina. Since it was first described, decompression was proposed instead of conservative treatment in acute CES caused by a lumbar disc hernia. But functional outcome may still be poor with postoperative perineal dysfunction in half of patients treated. The aim of this study is to compare the evolution of diagnostic method, time to surgery and outcome at follow-up in two distinct populations at thirty years interval in the same spine tertiary center. Material/patients and methods Study subjects were recruited from consecutive patients admitted to the Bordeaux hospital university spine center from November 2011 to June 2014. Inclusion criteria were: age greater than 18 years, admission in emergency, diagnosis of Cauda equina syndrome, compressive herniated disc, treated by discectomy only. Data were collected retrospectively and then compared to an historic population, surgically treated in the same center from September 1976 to May 1981. Results Thirteen patients (9 men, aged 43.9 ± 14.0 years) had a CES on admission. The historic population included 16 patients (12 men, age 52.6 ± 13.8 years). Spinal imaging techniques followed technical developments of MRI, with no more intradural radiculography. Delay time to surgery decreased from more than 2 days to less than 24 hours after diagnosis. Mean survey was 10 months. Information about urinary, digestive, walking and pain outcome were not fully available but present in more than half of the population. Outcome is poor in both populations. No patient returned to pre-compressive perineal status, more than 50% were able to walk without difficulty, and pain is present in half of the patients. Discussion – conclusion Cauda equina syndrome is rare but may result in a poor outcome. Caution is need in patients who consult in emergency for back and/or leg pain with herniated disc because more than one of ten had an associated perineal dysfunction, especially patients with high body mass index. Major developments are improved diagnostic ability by MRI, and improvements of physical retention treatment. Future studies, preferably prospective, have to explore and record data from each component of Cauda equina syndrome in long-term.