Département de Neurochirurgie, Hôpital de Bretonneau, Tours, France.
INSERM U1253, faculté de Tours, Tours, France.
Spine (Phila Pa 1976). 2022 Jan 15;47(2):105-113. doi: 10.1097/BRS.0000000000004170.
A prospective patient's database operated on a cauda equina syndrome (CES).
The aim of our study was to identify prognosis factors for favorable functional recovery after CES.
CES is a neurologic impairment of variable symptoms associating urinary, bowel, and sexual dysfunctions with or without motor or sensitive deficits caused by nerve root compression of the cauda equina. The definition of CES remains debated, as well as the prognosis factors for favorable functional recovery and the benefit of early surgery.
One hundred forty patients were included between January 2010 and 2019. Univariate and multivariate cox proportional hazard regression models were conducted.
The patients were young with a median age of 46.8 years (range 18-86 yrs). At presentation, 60% were affected by a motor deficit, 42.8% a sensitive deficit, 70% urinary dysfunctions, and 44% bowel dysfunctions. The mean follow-up was 15.5 months. Bilateral motor deficit (P = 0.017) and an initial deficit severity of 0 to 2 (P = 0.001) represented prognosis factors of poor motor recovery. Initial anal incontinence (P = 0.007) was associated with poor bowel recovery. Only 32.8% of the patients went back to work. Initial motor deficit (P = 0.015), motor sequelae (P = 0.001), sphincter dysfunctions sequelae (P = 0.02), and long LOS (P = 0.02) were poor return-to-work prognosis factors. Time to surgery within an early timing < 24 or 48 hours or later did not represent a prognosis factor of recovery in CES. Incomplete versus complete CES did not show better recovery.
CES remains a profound disabling syndrome with poor functional prognosis: in the long run, few patients go back to work. The main prognosis factors established in our series regarded the initial severity of deficits whether motor or sphincteral. Early or later surgical cauda equina decompression did not show to represent a prognosis factor for functional recovery.Level of Evidence: 4.
基于马尾综合征（CES）的前瞻性患者数据库。
我们的研究旨在确定 CES 后功能恢复良好的预后因素。
CES 是一种神经功能障碍，症状多样，伴有或不伴有运动或感觉缺陷，由马尾神经根受压引起，包括尿、肠和性功能障碍。CES 的定义仍存在争议，以及功能恢复良好的预后因素和早期手术的益处。
2010 年 1 月至 2019 年期间，共纳入 140 例患者。进行单变量和多变量 cox 比例风险回归模型分析。
患者年龄中位数为 46.8 岁（18-86 岁），较为年轻。就诊时，60%存在运动障碍，42.8%存在感觉障碍，70%存在尿功能障碍，44%存在肠功能障碍。平均随访时间为 15.5 个月。双侧运动障碍（P=0.017）和初始缺损严重程度 0-2 分（P=0.001）是运动功能恢复不良的预后因素。初始肛门失禁（P=0.007）与肠功能恢复不良相关。仅有 32.8%的患者能够重返工作岗位。初始运动障碍（P=0.015）、运动后遗症（P=0.001）、括约肌功能障碍后遗症（P=0.02）和 LOS 较长（P=0.02）是工作恢复不良的预后因素。在 CES 中，24 小时或 48 小时内手术或较晚手术的时间并不能作为恢复的预后因素。不完全 CES 与完全 CES 相比并未显示出更好的恢复效果。
CES 仍然是一种严重致残的综合征，功能预后不良：从长远来看，很少有患者能够重返工作岗位。在我们的研究中，确定的主要预后因素是运动或括约肌缺陷的初始严重程度。早期或晚期马尾减压手术并不能作为功能恢复的预后因素。
4 级。
