College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
Spine (Phila Pa 1976). 2019 Sep 1;44(17):1238-1247. doi: 10.1097/BRS.0000000000003045.
Systematic review and meta-analysis.
To examine the relationship between compressive pressure and its duration in cauda equina compression, and the effects of subsequent decompression, on neurophysiological function, and pathophysiology in animal studies. We further aim to investigate these relationships with systemic blood pressure to assess whether a vascular component in the underlying mechanism may contribute to the clinical heterogeneity of this disease.
The complex relationship between preoperative factors and outcomes in cauda equina syndrome (CES) suggests heterogeneity within CES which may inform better understanding of pathophysiological process, their effect on neurological function, and prognosis.
Systematic review identified 17 relevant studies including 422 animals and reporting electrophysiological measures (EP), histopathology, and blood flow. Modeling using meta-regression analyzed the relationship between compressive pressure, duration of compression, and electrophysiological function in both compression and decompression studies.
Modeling suggested that electrophysiological dysfunction in acute cauda equina compression has a sigmoidal response, with particularly deterioration when mean arterial blood pressure is exceeded and, additionally, sustained for approximately 1 hour. Accounting for pressure and duration may help risk-stratify patients pre-decompression. Outcomes after decompression appeared to be related more to the degree of compression, where exceeding systolic blood pressure tended to result in an irreversible lesion, rather than duration of compression. Prognosis was most strongly associated with residual pre-decompression function.
Compressive pressure influences effects and outcomes of cauda equina compression. We suggest the presence of two broad phenotypic groups within CES defined by the degree of ischaemia as a potential explanatory pathophysiological mechanism.
系统评价和荟萃分析。
研究马尾受压时的压缩压力及其持续时间与随后减压对动物神经生理功能和病理生理学的关系，并进一步研究其与全身血压的关系，以评估血管因素是否可能是导致该疾病临床异质性的原因之一。
马尾综合征（CES）术前因素与结局的复杂关系表明 CES 存在异质性，这可能有助于更好地了解病理生理过程、它们对神经功能的影响和预后。
系统评价确定了 17 项相关研究，包括 422 只动物，并报告了电生理测量（EP）、组织病理学和血流情况。荟萃回归分析用于分析压缩和减压研究中压缩压力、压缩持续时间与电生理功能之间的关系。
模型表明，急性马尾受压时的电生理功能障碍呈“S”型反应，当平均动脉压超过且持续约 1 小时时，功能障碍尤其严重。考虑到压力和持续时间可能有助于在减压前对患者进行风险分层。减压后的结果似乎与压缩的严重程度有关，超过收缩压往往会导致不可逆转的损伤，而不是压缩持续时间。预后与减压前的残留功能最密切相关。
压缩压力影响马尾受压的影响和结局。我们提出 CES 存在两种广泛的表型组，其特征是缺血程度，这可能是一种潜在的解释性病理生理学机制。
1。
