Analysis of clinical and neurological outcomes in patients with cauda equina syndrome caused by acute lumbar disc herniation: a retrospective-prospective study

OBJECTIVES: In this research we analyzed the results of surgical treatment of cauda equina syndrome (CES) caused by acute lumbar disc herniation. We emphasize the early treatment for good neurological recovery. METHODS: A retrospective-prospective, non randomized, clinical study was performed between Jan 2010 and Dec 2014. We retrospectively collected medical records of 18 patients who suffered from CES due to acute lumbar disc herniation and followed up them regularly. Visual analogue scale (VAS) score, lumbar JOA score (29 points), RR (recovery rate) and Oswestry disability index (ODI) questionnaire were used to evaluate clinical outcomes. RESULTS: All patients were followed up for at least two years. Lumbar disc herniation is located at L2-3 level in 2 cases, L3-4 level in 2 cases, L4-5 level in 9 cases, L5-S1 level in 5 cases. VAS score is 6±2.5 preoperatively and 1.5±1.0 postoperatively at last follow-up (P<0.001). JOA score is 5±3.5 preoperatively, while it is 20±7 postoperatively at last follow-up (P<0.001). RR ≥ 50% was found in 12 cases. ODI is 75%±25% preoperatively, while it becomes 28%±16% postoperatively at last follow-up (P<0.001). It also shows that advanced age (≥45 years) may act as a risk factor for poor RR(<50%), while early operation (duration before surgery, <48 h) proves to be a protective factor. CONCLUSIONS: Early operations are mandatory and closely relevant to final outcomes for CES patients. However, elder patients are more likely to have poor clinical effect after surgery.