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手术减压能否缓解因腰椎间盘突出症和/或退行性椎管狭窄导致的马尾神经综合征？

Does surgical decompression alleviate neglected cauda equina syndromes attributed to lumbar disc herniation and/or degenerative canal stenosis?

作者信息

Sath Sulaiman

机构信息

Department of Spine Services , Indian Spinal Injuries Centre, New Delhi, India.

出版信息

Surg Neurol Int. 2020 Sep 5;11:278. doi: 10.25259/SNI_512_2020. eCollection 2020.

DOI:10.25259/SNI_512_2020
PMID:33033640
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7538965/
Abstract

BACKGROUND

Most studies recommend urgent decompression (e.g., within 48-72 h) of the symptomatic onset of a cauda equina syndrome. As patients in our area typically underwent >3 months delayed surgery for cauda equina syndromes due to disc disease/stenosis, we asked whether surgery was still worthwhile.

METHODS

This was a retrospective analysis of 12 patients (2012-2018) who underwent delayed surgical decompression for cauda equina syndromes secondary to lumbar disc herniations and/or degenerative lumbar canal stenosis.

RESULTS

After a mean postoperative duration of 8.22 months, nine patients experienced the complete restoration of bladder status; two patients required intermittent self-catheterization, while one patient had some residual symptoms (e.g., urgency but able to void with some difficulty).

CONCLUSION

For 12 patients who originally presented with cauda equina syndrome with complete incontinence, nine exhibited delayed full recovery of bladder function with average of 8.22 months postoperatively. We would, therefore, advise that delayed surgical decompression be offered to these patients, irrespective of the preoperative duration of cauda equina syndromes with complete incontinence.

摘要

背景

大多数研究建议在马尾综合征症状出现后紧急减压（如在48 - 72小时内）。由于我们地区的患者因椎间盘疾病/椎管狭窄导致马尾综合征通常延迟超过3个月才进行手术，我们探讨了手术是否仍有价值。

方法

这是一项对12例患者（2012 - 2018年）的回顾性分析，这些患者因腰椎间盘突出症和/或退变性腰椎管狭窄继发马尾综合征而接受了延迟手术减压。

结果

术后平均8.22个月，9例患者膀胱功能完全恢复；2例患者需要间歇性自我导尿，1例患者有一些残余症状（如尿急，但排尿有一定困难）。

结论

对于最初表现为完全性尿失禁的12例马尾综合征患者，9例术后平均8.22个月膀胱功能延迟完全恢复。因此，我们建议对这些患者进行延迟手术减压，无论术前完全性尿失禁的马尾综合征持续时间如何。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/436660cc5365/SNI-11-278-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/5958414513b9/SNI-11-278-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/963ced6a0e8a/SNI-11-278-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/12575a4060ba/SNI-11-278-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/c44868eae0c5/SNI-11-278-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/f8004686a785/SNI-11-278-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/ab77ec2c3589/SNI-11-278-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/885ed450dcc0/SNI-11-278-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/436660cc5365/SNI-11-278-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/5958414513b9/SNI-11-278-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/963ced6a0e8a/SNI-11-278-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/12575a4060ba/SNI-11-278-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/c44868eae0c5/SNI-11-278-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/f8004686a785/SNI-11-278-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/ab77ec2c3589/SNI-11-278-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/885ed450dcc0/SNI-11-278-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b09a/7538965/436660cc5365/SNI-11-278-g008.jpg

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Time to Surgery and Outcomes in Cauda Equina Syndrome: An Analysis of 45 Cases.马尾综合征的手术时机与预后：45例病例分析
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