Prospective study of Cauda equina syndrome with particular reference to bladder recovery pattern: An institutional study.

Srikrishna Majhi; Sabyasachi Saha; Anup Kumar Chaudhuri

Volume : X, Issue : II, February - 2020

Prospective study of Cauda equina syndrome with particular reference to bladder recovery pattern: An institutional study.

Srikrishna Majhi, Sabyasachi Saha, Anup Kumar Chaudhuri

Abstract :

Objective: The primary objective of this study was to analyze the bladder recovery patterns in patients admitted with cauda equina syndrome (CES) at the Bangur Institute of Neuroscience, Kolkata, India from May 2018 to Oct 2019. Methods: This was a single center prospective study done at Bangur Institute of Neuroscience, Kolkata, India from May 2018 to Oct 2019. Patients admitted with diagnosis of cauda equina syndrome were included in the study. The following variables were analyzed: gender, age, etiology of the disease, level of the injury, time interval between onset of symptoms and surgery, peri anal sensation (PAS), voluntary anal contraction (VAC), types of surgeries performed, complications, post operative bladder recovery (complete, partial, no recovery). Results: Overall, 32 patients were included in the study. Most of them were males (78 %) with an average age of 38.1 years. Most common cause of CES in our study was lumbar disc herniation and L4L5 level was most commonly involved. Only 6 patients (18%) presented before 48 hrs. All of the patients had involvement of bladder function at presentation. On calculation of the association of different factors with bladder recovery pattern we have found that patients undergoing surgery in less than 48 hrs of symptom onset had good bladder recovery than those patients who underwent surgery after 48 hrs and the result is statistically significant (p value 0.008). No bladder recovery was observed in patients with absent anal tone (the result is statistically significant, p value 0.024). Conclusion: So the prospective observational study showed that Cauda equina syndrome is most commonly caused by lumbar prolapsed disc disease. There is significant delay in presentation which is caused by delay in diagnosis and referral. Better outcome in bladder recovery was found in patients who presented to the health facility within 48 hrs and underwent surgery within 48 hrs.