Department of Orthopaedics, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhan, India.
Eur J Trauma Emerg Surg. 2022 Apr;48(2):1009-1016. doi: 10.1007/s00068-020-01589-6. Epub 2021 Jan 16.
To evaluate the recovery of urinary functions and the factors predicting urinary recovery, following delayed decompression in complete cauda equina syndrome (CESR) secondary to Lumbar disc herniation (LDH).
Retrospective study evaluated 19 cases of CESR due to single-level LDH, all presenting beyond 72 h. Mean delay in decompression was 11.16 ± 7.59 days and follow-up of 31.71 ± 13.90 months. Urinary outcomes were analysed on two scales, a 4-tier ordinal and a dichotomous scale. Logistic regression analysis was used for various predictors including delay in decompression, age, sex, radiation, level of LDH, motor deficits, type and severity of presentation. Time taken to full recovery was correlated with a delay in decompression. using Spearman-correlation.
Optimal recovery was seen in 73.7% patients and time to full recovery was moderately correlated with a delay in decompression (r = 0.580, p = 0.030). For those with optimal bladder recovery, mean recovery time was 7.43 ± 5.33 months. Time to decompression and other evaluated factors were not found contributory to urinary outcomes on either scales. Three (15.8%) patients had excellent, 11 (57.9%) had good, while 3 (15.8%) and 2 (10.5%) had fair and poor outcomes respectively.
Occurrence of CESR is not a point of no-return and complete recovery of urinary functions occur even after delayed decompression. Longer delay leads to slower recovery but it is not associated with the extent of recovery. Since time to decompression is positively correlated with time to full recovery, early surgery is still advised in the next available optimal operative setting.
IV.
评估腰椎间盘突出症（LDH）继发完全马尾综合征（CESR）延迟减压后尿功能恢复情况及预测尿功能恢复的因素。
回顾性研究分析了 19 例单节段 LDH 导致的 CESR 患者，所有患者均在发病后 72 h 以上就诊。减压平均延迟时间为 11.16±7.59 天，随访时间为 31.71±13.90 个月。尿功能采用 4 级有序和二分类两种量表进行分析。采用逻辑回归分析包括减压延迟、年龄、性别、放疗、LDH 水平、运动障碍、起病类型和严重程度等各种预测因素。使用 Spearman 相关分析来评估完全恢复时间与减压延迟时间之间的相关性。
73.7%的患者恢复良好，完全恢复时间与减压延迟时间呈中度相关（r=0.580，p=0.030）。对于那些膀胱功能完全恢复的患者，平均恢复时间为 7.43±5.33 个月。在两种量表上，时间到减压和其他评估因素都与尿功能结果无关。3 例（15.8%）患者为优，11 例（57.9%）为良，3 例（15.8%）和 2 例（10.5%）为可和差。
CESR 的发生并不是不可逆转的，即使在延迟减压后，尿功能也可以完全恢复。延迟时间越长，恢复越慢，但与恢复程度无关。由于减压时间与完全恢复时间呈正相关，因此仍建议在可及的最佳手术时机尽早进行手术。
IV 级。
