Korse N S, Pijpers J A, van Zwet E, Elzevier H W, Vleggeert-Lankamp C L A
Department of Neurosurgery, Leiden University Medical Center, LUMC, Postzone J11-R-83, Postbus 9600, 2300 RC, Leiden, The Netherlands.
Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
Eur Spine J. 2017 Mar;26(3):894-904. doi: 10.1007/s00586-017-4943-8. Epub 2017 Jan 19.
Even though micturition, defecation, and sexual function are substantially affected in cauda equina syndrome (CES), data on outcome are scarce.
Medical files of patients operated on lumbar herniated disc were screened for CES and retrospectively analyzed for baseline characteristics, outcome of micturition, defecation, and sexual function and possible predictors.
Seventy-five CES patients (52% men) were included with a mean age of 44 years. L5-S1 was the most common affected level. Duration of CES complaints at presentation was, on average, 84 h (median 48 h). Prevalence of symptoms at presentation: sciatica (97%), altered sensation of the saddle area (93%), micturition dysfunction (92%), and defecation dysfunction (74%). Only 26 patients were asked about sexual dysfunction of whom 25 patients experienced dysfunction. Female gender was associated with more defecation dysfunction at presentation than male gender (OR 4.11; p = 0.039). All patients underwent decompressive surgery. Two post-operative follow-up (FU) moments took place after a mean of 75 h and 63 days. Outcomes at second FU moment: micturition dysfunction 48%, defecation dysfunction 42%, sexual dysfunction 53%, sciatica 48%, and altered sensation of the saddle area 57%. A shorter time to decompression was associated with more sciatica at FU 1 (p = 0.042) which effect had disappeared at FU 2.
This study is unique in (1) displaying the presenting features in a large cohort of CES patients, (2) demonstrating that recovery after decompression is slow and far from complete in the majority of patients with regard to micturition, defecation, and sexual function and (3) evaluating predictors for outcome.
尽管马尾神经综合征（CES）患者的排尿、排便和性功能受到严重影响，但关于其预后的数据却很稀少。
对接受腰椎间盘突出症手术的患者病历进行筛查，以确定是否患有CES，并对其基线特征、排尿、排便和性功能的预后以及可能的预测因素进行回顾性分析。
纳入75例CES患者（52%为男性），平均年龄44岁。L5-S1是最常见的受累节段。就诊时CES症状的持续时间平均为84小时（中位数为48小时）。就诊时症状的发生率：坐骨神经痛（97%）、鞍区感觉改变（93%）、排尿功能障碍（92%）和排便功能障碍（74%）。仅对26例患者询问了性功能情况，其中25例患者存在性功能障碍。女性在就诊时排便功能障碍比男性更多（比值比4.11；p = 0.039）。所有患者均接受了减压手术。术后平均75小时和63天进行了两次随访。第二次随访时的结果：排尿功能障碍48%、排便功能障碍42%、性功能障碍53%、坐骨神经痛48%、鞍区感觉改变57%。减压时间较短与随访1时更多的坐骨神经痛相关（p = 0.042），但在随访2时该效应消失。
本研究的独特之处在于：（1）展示了一大群CES患者的就诊特征；（2）表明减压后在大多数患者中，排尿、排便和性功能方面的恢复缓慢且远未完全恢复；（3）评估了预后的预测因素。
