Clinical Outcome Based Cauda Equina Syndrome Scoring System for Prediction of Prognosis

ABSTRACT

STUDY DESIGN: This is a retrospective study. OBJECTIVES: We made a scoring system using the symptoms of cauda equina syndrome(CES) and we studied the efficacy of the scoring system. SUMMARY OF THE LITERATURE REVIEW There has been no definite scoring system with clear factors that can predict the clinical results of cauda equine syndrome. MATERIALS AND METHODS: Between 1998 and 2006, 21 patients who were diagnosed with CES and who were followed for more than 2 years were enrolled in this study. There were 6 cases of HIVD, 6 cases of degenerative spondylosis, 7 cases of vertebral fracture and 2 cases of metastatic spinal tumor. We made a scoring system for CES (SSCES) using 8 symptoms among the general clinical manifestations that accompany CES, which are low back pain, sciatic neuropathy, sensory and motor disorder of the lower extremities, loss of a saddle sensation, voiding difficulty, disorder of the anal sphincter tone and deep tendon reflex disorder. RESULTS: The last clinical outcomes were 3 excellent patients, 5 good patients, 5 fair patients and 8 poor patients. The mean preoperative SSCES was 11.7+/-2.8(7-16) and the mean final follow up score was 7.6+/-3.4(2-13). Eight cases that had a mean preoperative SSCES score of 6 or below showed good clinical results with a mean SSCES of 3.9+/-11(2-5) on the final follow up, and 13 cases with a mean preoperative SSCES score of 7 or above showed bad clinical results with a mean SSCES of 9.9+/-1.9(7-13) on the final follow up. CONCLUSIONS: The prognosis was better on the final follow up for the patients with a lowere preoperative SSCES. So, for the treatment of CES, preoperative evaluation using the SSCES is thought to be very useful for predicting the prognosis.