Department of Orthopedic Surgery, Spine Center, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China.
Eur J Med Res. 2024 Oct 8;29(1):493. doi: 10.1186/s40001-024-02067-0.
Cauda equina syndrome with retention (CESR) is a severe lumbar condition characterized by painless urine retention due to cauda equina nerve injury. The standard treatment, posterior lumbar interbody fusion (PLIF), often yields suboptimal results. This study aims to compare the clinical safety and efficacy of a novel technique, capsule lumbar interbody fusion (CLIF), with PLIF in CESR patients, hypothesizing that CLIF can enhance neurological recovery by reducing nerve tension.
A single-center, retrospective study was conducted on 83 patients with CESR due to lumbar disc herniation, who underwent either PLIF (n = 44) or CLIF (n = 39). Patients were assessed preoperatively and at 3, 12, and 24 months postoperatively using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF), and Rintala score. Urodynamic studies and nerve tension measurements were also performed. Statistical analysis included t tests, Mann-Whitney U tests, and Spearman's correlation.
Both groups showed significant postoperative improvements, but the CLIF group had superior outcomes. At 12 months, the CLIF group had lower VAS scores (1.15 ± 0.84 vs. 1.68 ± 0.60, p = 0.001) and ODI scores (23.31 ± 7.51 vs. 28.30 ± 8.26, p = 0.005). At 24 months, the CLIF group continued to show better results with ODI scores (15.97 ± 6.43 vs. 22.11 ± 6.41, p < 0.001) and higher ODI recovery rates (60.41 ± 17.6% vs. 44.71 ± 18.99%, p < 0.001). The CLIF group also had better ICI-Q-SF scores (2.13 ± 1.23 vs. 3.02 ± 1.45, p = 0.004) and Rintala scores (17.97 ± 1.43 vs. 16.59 ± 1.54, p < 0.001). Lower postoperative nerve tension in the CLIF group correlated with these improved outcomes.
CLIF demonstrated superior efficacy over PLIF in treating CESR, with significant improvements in pain relief, functional recovery, and bladder and bowel function. This study highlights the potential of CLIF as a more effective surgical option for CESR, emphasizing its importance in improving patient outcomes and reducing the burden of CESR on patients and society.
马尾综合征伴尿潴留（CESR）是一种严重的腰椎疾病，表现为马尾神经根损伤导致无痛性尿潴留。标准治疗方法为后路腰椎间融合术（PLIF），但往往效果不佳。本研究旨在比较新型胶囊腰椎间融合术（CLIF）与 PLIF 治疗 CESR 的临床安全性和疗效，假设 CLIF 可通过降低神经张力来促进神经恢复。
本研究为单中心回顾性研究，纳入了 83 例因腰椎间盘突出症导致 CESR 的患者，其中 44 例接受 PLIF 治疗（PLIF 组），39 例接受 CLIF 治疗（CLIF 组）。患者分别在术前、术后 3、12 和 24 个月进行 Oswestry 功能障碍指数（ODI）、视觉模拟评分（VAS）、国际尿失禁咨询问卷简表（ICI-Q-SF）和 Rintala 评分评估。同时还进行了尿动力学研究和神经张力测量。统计学分析采用 t 检验、Mann-Whitney U 检验和 Spearman 相关分析。
两组患者术后均有显著改善，但 CLIF 组的疗效更佳。术后 12 个月，CLIF 组的 VAS 评分（1.15±0.84 比 1.68±0.60，p=0.001）和 ODI 评分（23.31±7.51 比 28.30±8.26，p=0.005）更低。术后 24 个月，CLIF 组的 ODI 评分（15.97±6.43 比 22.11±6.41，p<0.001）和 ODI 恢复率（60.41±17.6%比 44.71±18.99%，p<0.001）更高。CLIF 组的 ICI-Q-SF 评分（2.13±1.23 比 3.02±1.45，p=0.004）和 Rintala 评分（17.97±1.43 比 16.59±1.54，p<0.001）也更好。CLIF 组术后神经张力较低，与这些改善结果相关。
CLIF 治疗 CESR 的疗效优于 PLIF，可显著缓解疼痛，促进功能恢复，改善膀胱和肠道功能。本研究强调了 CLIF 作为 CESR 更有效治疗方法的潜力，有助于改善患者结局，减轻 CESR 对患者和社会的负担。
