Aly Tarek A, Aboramadan Mohamed Osama
Orthopedics. 2014 Feb;37(2):e153-6. doi: 10.3928/01477447-20140124-18.
Cauda equina syndrome (CES) is a rare but serious neurosurgical emergency that can have devastating long-lasting neurologic consequences. Compression of the cauda equina can result in paralysis of bowel and bladder function. Such compression has been considered the only absolute indication for surgery in cases of lumbar disk disease. Therefore, it is extremely important that physicians be aware of the condition so that a surgeon is consulted before neurological damage becomes permanent. This article reports the results of delayed surgical decompression in cases of lumbar disk herniation with CES. The study group comprised 14 patients (11 men and 3 women) with a mean age of 48 years (range, 36-57 years). Clinical presentation was chronic low back pain, sciatica, and impaired sphincter function. All patients had a fenestration at the affected level and site, and the disk fragments were excised and the disk space cleared. The surgeries were performed 1 to 3 months after onset of sphinctric disturbance. Postoperatively, all patients were relieved of back and/or leg pain and showed sensory improvement. Twelve patients regained full control of urination and defecation. Lower extremity strength improved in 9 patients. The classical presentation of CES is not obvious. Even if surgery is performed late due to delayed presentation, significant improvement in neurologic and bladder function can still be expected.
马尾综合征（CES）是一种罕见但严重的神经外科急症，可导致严重的、长期的神经功能后果。马尾受压可导致肠道和膀胱功能麻痹。这种压迫被认为是腰椎间盘疾病患者手术的唯一绝对指征。因此，医生了解这种情况非常重要，以便在神经损伤永久化之前咨询外科医生。本文报告了腰椎间盘突出症合并CES患者延迟手术减压的结果。研究组包括14例患者（11例男性和3例女性），平均年龄48岁（范围36 - 57岁）。临床表现为慢性腰痛、坐骨神经痛和括约肌功能障碍。所有患者均在受累节段和部位进行了开窗手术，切除了椎间盘碎片并清理了椎间隙。手术在括约肌功能障碍发作后1至3个月进行。术后，所有患者的背部和/或腿部疼痛均得到缓解，感觉功能有所改善。12例患者恢复了排尿和排便的完全控制。9例患者下肢力量有所改善。CES的典型表现并不明显。即使由于就诊延迟而手术较晚，神经和膀胱功能仍有望得到显著改善。
