Bydon Mohamad, Lin Joseph A, De la Garza-Ramos Rafael, Macki Mohamed, Kosztowski Thomas, Sciubba Daniel M, Wolinsky Jean-Paul, Witham Timothy F, Gokaslan Ziya L, Bydon Ali
Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2016 Mar;87:110-5. doi: 10.1016/j.wneu.2015.12.054. Epub 2015 Dec 24.
The objective of this study is to analyze time to surgery as both a continuous and discrete variable to determine its association with outcomes in cauda equina syndrome (CES).
Patients at a single center whose medical record allowed precise calculation of time to surgery were included. CES was defined as at least four of the following: bladder dysfunction, saddle anesthesia, lower extremity weakness, lower extremity sensory disturbance, bowel dysfunction, or acute lower back or leg pain. Time to surgery was analyzed as a continuous variable using logistic and ordered logistic regression, and as a discrete variable by comparing patients treated before and after set thresholds.
Forty-five patients were identified. Analysis of time as a continuous variable did not reveal any significant association with outcomes. A parsimonious model with adjustment for age, sex, race, acute onset of CES, saddle anesthesia, motor deficit, and bowel dysfunction at presentation was used to analyze the continuous influence of time to surgery on bladder dysfunction and an aggregate outcome of symptoms. Neither time to surgery nor any of the covariates were significantly associated with either outcome. Discrete analysis of outcomes across thresholds of 12, 24, 36, 48, 60, and 72 hours did not reveal prognostic time points.
In this single-center CES series, time to surgery did not have a convincing continuous or discrete relationship with outcome. Future prospective studies are needed to determine the best timing for surgery in patients with CES.
本研究的目的是将手术时间作为连续变量和离散变量进行分析，以确定其与马尾综合征（CES）预后的关联。
纳入单中心病历允许精确计算手术时间的患者。CES定义为具备以下至少四项：膀胱功能障碍、鞍区感觉缺失、下肢无力、下肢感觉障碍、肠道功能障碍或急性下背部或腿部疼痛。手术时间作为连续变量，采用逻辑回归和有序逻辑回归进行分析；作为离散变量，通过比较设定阈值前后接受治疗的患者进行分析。
共确定45例患者。将时间作为连续变量分析未发现其与预后有任何显著关联。采用一个简约模型，对年龄、性别、种族、CES急性起病、鞍区感觉缺失、运动功能缺损及就诊时肠道功能障碍进行校正，以分析手术时间对膀胱功能障碍及症状综合预后的持续影响。手术时间及任何协变量均与任一预后无显著关联。对12、24、36、48、60和72小时阈值的预后进行离散分析，未发现预后时间点。
在这个单中心CES系列研究中，手术时间与预后之间不存在令人信服的连续或离散关系。需要未来的前瞻性研究来确定CES患者的最佳手术时机。
