Predictors of outcome in cauda equina syndrome

This retrospective review examined the cause, level of pathology, onset of symptoms, time taken to treatment, and outcome of 19 patients with cauda eq uina syndrome (CES). The minimum time to follow up was 22 months. Logistica l regression analysis was used to determine how these factors influenced th e eventual outcome. Out of 19 patients, 14 had satisfactory recovery at 2 y ears post-decompression: 5 patients were left with some residual dysfunctio n. The mean rime to decompression in the group with a Satisfactory outcome was 14 h (range 6-24 h) whilst that of the group with the poor outcome was 30 h (range 20-72 h). There was a clear correlation between delayed decompr ession and a poor outcome (P = 0.023), Saddle hypoaesthesia was evident in all patients. In addition complete perineal anaesthesis was evident in 7/19 patients, 5 of whom developed a poor outcome. Bladder dysfunction was obse rved in 19/19 patients, with 12/19 regarded as having significant impairmen t. Of the five patients identified as having a poor overall outcome, all fi ve presented with a significant sphincter disturbance and 4/5 were left wit h residual sphincter dysfunction. There was a clear correlation between the presence of complete perineal anaesthesia and significant sphincter dysfun ction as both univariate and multivariate predictors of a poor overall outc ome. The association between a slower onset of CES and a more favourable ou tcome did not reach statistical significance (P = 0.052). No correlation co uld be found between initial motor function loss, bilateral sciatica, level or cause of injury as predictors of a poor outcome (P > 0.05). CES can be diagnosed early by judicious physical examination, with particular attentio n to perineal sensation and a history of urinary dysfunction. The most impo rtant factors identified in this series as predictors of a favourable outco me in CES were early diagnosis and early decompression.