Original Articles
To study the factors that influence the recovery of patients with prolapsed lumbar intervertebral disc and cauda equina syndrome | |
Dr. Gograj Garhwal, Dr. Dilip Nagarwal, Dr. Sushil Acharya, Dr. Kamlakant Khatri, Dr. Piyush Kumar Modi | |
Aim: To study the factors that influence the recovery of patients with prolapsed lumbar intervertebral disc and cauda equina syndrome. Materials and Methods: This prospective study was conducted in the Department of Neurosurgery, focusing on 50 cases of cauda equina syndrome (CES) due to lumbar intervertebral disc herniation. Inclusion criteria were broad, encompassing patients of all age groups and sexes who presented with symptoms and signs of cauda equina syndrome due to a prolapsed lumbar intervertebral disc. Recurrent cases of cauda equina syndrome due to prolapsed lumbar intervertebral disc were also included in the study. Overall surgical outcome was evaluated as good (complete recovery of bowel and bladder function, saddle anesthesia, sciatica, sensory and motor power), fair (complete recovery of sciatica, saddle anesthesia, and defecation dysfunction, with some difficulty during micturition but no need for intermittent catheterization), and poor (low back pain and sciatica recovered in most patients, some recovery of saddle anesthesia and bowel and bladder dysfunction, and required intermittent catheterization). Results: Patients were categorized into complete CES (CES-R) and incomplete CES (CES-I) based on the severity of their symptoms. Twenty patients (40%) were classified as having complete CES, characterized by more severe neurological deficits such as painless urinary retention or fecal incontinence. The remaining 30 patients (60%) were classified as having incomplete CES, with less severe symptoms such as altered urinary sensation and decreased perianal sensory loss.Bladder outcomes were assessed six months post-surgery. Twenty patients (40%) had an excellent outcome, with normal bladder function and no residual symptoms. Fifteen patients (30%) showed a good outcome, with definite improvement and residual urine volume less than 100ml without the need for intermittent catheterization. The remaining 15 patients (30%) had a poor outcome, requiring intermittent catheterization with residual urine volume greater than 100ml. These results highlight the variability in bladder recovery among CES patients.The overall surgical outcomes were evaluated at six months post-surgery. Twenty-five patients (50%) had a good outcome, with complete recovery of bowel and bladder function, saddle anesthesia, sciatica, and sensory and motor power. Fifteen patients (30%) had a fair outcome, with recovery of sciatica, saddle anesthesia, and defecation dysfunction, but some difficulty during micturition without the need for intermittent catheterization. Ten patients (20%) had a poor outcome, with some recovery of saddle anesthesia and bowel and bladder dysfunction but required intermittent catheterization. These outcomes underscore the importance of timely and appropriate surgical intervention in improving the prognosis of CES patients. Conclusion: The study highlights the critical role of timely and appropriate surgical intervention in the management of cauda equina syndrome. The variability in symptom onset, severity, and recovery outcomes underscores the need for individualized treatment plans. |
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