The Centre for Spinal Studies and Surgery, QMC, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic.
Neurosurgery. 2018 Dec 1;83(6):1193-1200. doi: 10.1093/neuros/nyx607.
Timing of surgery and the importance of the size of disc prolapse in cauda equina syndrome (CES) remain controversial.
To investigate whether there is a relationship between postoperative urinary function, preoperative duration of neurogenic lower urinary tract dysfunction (NLUTD), and the level of canal compromise.
Seventy-one patients operated for CES were prospectively identified between 2010 and 2013. Fifty-two cases with preoperative NLUTD were included. The "Prolapse: Canal ratio" (PCR) was calculated as a proportion of cross-sectional area of disc prolapse on total cross-sectional area of spinal canal.
Median of preoperative duration of NLUTD was 72 h (48; 132) and period from first assessment to surgery 10.5 h (7; 18.5). Urinary incontinence was seen in 46.2% of patients, 38.4% had painless retention and 15.4% had painful retention. In 38.5% of cases, urinary symptoms persisted for more than 20 mo postoperatively. There was no correlation between duration of preoperative NLUTD and urinary dysfunction persistence (P = .921). The outcome was not significantly influenced by having surgery more than the 48 h after presentation (P = .135). Preoperative incontinence persisted in 58% and painless retention in 30% of cases. The mean PCR was 0.6 ± 0.18. There was no correlation between PCR and outcome (P = .537) even after adjusting for duration of preoperative NLUTD (P = .7264).
No significant correlation was demonstrated between the preoperative duration of urinary dysfunction, the size of disc herniation relative to size of spinal canal, and postoperative urinary function in a large consecutive series of patients with CES.
手术时机和马尾综合征（CES）椎间盘突出物大小的重要性仍存在争议。
探讨术后尿功能与术前神经源性下尿路功能障碍（NLUTD）持续时间及椎管狭窄程度之间是否存在相关性。
前瞻性纳入 2010 年至 2013 年间接受 CES 手术的 71 例患者，其中 52 例术前存在 NLUTD。计算椎间盘突出物与椎管横截面积的比例（PCR）。
术前 NLUTD 的中位持续时间为 72 h（48；132），从首次评估到手术的时间为 10.5 h（7；18.5）。46.2%的患者存在尿失禁，38.4%的患者存在无痛性潴留，15.4%的患者存在疼痛性潴留。38.5%的患者术后 20 个月以上仍存在尿症状。术前 NLUTD 的持续时间与尿功能障碍的持续时间无相关性（P=0.921）。术后 48 小时后手术对结果无显著影响（P=0.135）。术前尿失禁持续存在 58%，无痛性潴留持续存在 30%。平均 PCR 为 0.6±0.18。即使在校正术前 NLUTD 持续时间后，PCR 与结果之间也无相关性（P=0.537）（P=0.7264）。
在一项大型连续 CES 患者系列中，术前尿功能障碍持续时间、椎间盘突出物与椎管大小的比值与术后尿功能之间未显示出显著相关性。
