Lumbar herniated disc presenting with cauda equina syndrome long-term follow-up of four cases

BACKGROUND Cauda equina syndrome is a relatively rare presenting symptom of lumbar her niated discs. Early operative decompression is advocated, but it may not al ways restore the bladder function. In such cases, knowing the long-term out come of bladder or sphincter disturbances is quite useful in planning the m anagement of these patients. METHODS Hospital records of patients operated on for lumbar herniated discs were re viewed. Charts and imaging studies of those patients who presented with cla ssic cauda equina syndrome were analyzed. RESULTS There were 4 patients (2.8%) of 144 consecutive surgical series of lumbar d isc herniation, whose presenting symptom was classic cauda equina syndrome. Postoperatively, the patients had been followed at the clinic for a mean p eriod of 6.4 years. Certain characteristic findings were noted on patients' neurological and radiological examinations. Although the recovery process of bladder function was very slow, taking months to years, all four patient s achieved almost normal voiding with no major impairment of daily activiti es. CONCLUSIONS Even if short-term recovery of bladder function is poor after lumbar disc s urgery for cauda equina syndrome, the long-term outcome is not necessarily so. We should follow up on these patients with such measures as intermitten t self-catheterization and drug therapy, expecting slow but steady recovery of bladder and sphincter function. (C) 2000 by Elsevier Science Inc.