Acute Cauda Equina Syndrome Secondary to Lumbar Disc Herniation

ABSTRACT

OBJECTIVE: Acute cauda equina syndrome secondary to lumbar disc herniation is a rare clinical entity, but its sequelae such as bladder and sexual dysfunction are too severe to overlook. The purpose of this study is to determine the relationship between surgical timing and outcome. METHODS: Between 1994 and 1999, 43 patients(34 male and 9 female), ranging in age from 19 to 67 years(mean 44.5), were operated due to acute cauda equina syndrome secondary to lumbar disc herniation. All presented with bladder and bowel dysfunction36(83.7%) had motor weakness and 32(74.4%) had sensory deficit. The levels of herniations were L4/5 in 16 patients, L5/S1 in 10 and L3/4 in 5. RESULTS: The time to surgery from the onset of the symptom ranged from less than 24 hours to more than 14 days10 patients underwent surgery within 48 hours of onset. The mean follow-up period was 54 months. In motor function recovery, there was no significant difference, but in bladder and sexual functions, there was significant difference according to the duration of symptoms before surgery. CONCLUSION: In acute cauda equina syndrome, emergency decompression surgery should be done. The outcome is good in patients operated within 48 hours compared to those treated more than 48 hours after the onset of the syndrome.