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Review/Perspective: Operations for Cauda Equina Syndromes - “The Sooner the Better”
BACKGROUND: Although most studies recommended that early surgery for cauda equina syndromes (CES) be performed within <48 h., the largest and most comprehensive Nationwide Inpatient Sample Database (NISC) series, involving over 25,000 CES patients recommended that time be shortened to 0–<24 h....
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Scientific Scholar
2022
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8986648/ https://www.ncbi.nlm.nih.gov/pubmed/35399881 http://dx.doi.org/10.25259/SNI_170_2022 |
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author | Epstein, Nancy E. |
author_facet | Epstein, Nancy E. |
author_sort | Epstein, Nancy E. |
collection | PubMed |
description | BACKGROUND: Although most studies recommended that early surgery for cauda equina syndromes (CES) be performed within <48 h., the largest and most comprehensive Nationwide Inpatient Sample Database (NISC) series, involving over 25,000 CES patients recommended that time be shortened to 0–<24 h. In short, CES surgery performed “the sooner the better,” was best. METHODS: The 2 major variants of CES include; incomplete/partial ICES, and those with urinary retention/bowel incontinence (RCES). Those with ICES often exhibit varying combinations of motor weakness, sensory loss (i.e. including perineal numbness), and urinary dysfunction, while RCES patients typically exhibit more severe paraparesis, sensory loss including saddle anesthesia, and urinary/bowel incontinence. The pathology responsible for ICES/RCES syndromes may include; acute disc herniations/stenosis, trauma (i.e. including iatrogenic/ surgical hematomas etc.), infections, abscesses, and other pathology. Surgery for either ICES/RCES may include decompressions to multilevel laminectomies/fusions. RESULTS: Following early surgery, most studies showed that ICES and RCES patients exhibited improvement in motor weakness and sensory loss. However, recovery of sphincter function was more variable, being poorer for RCES patients with preoperative urinary retention/bowel incontinence. CONCLUSIONS: Although early CES surgery was defined in most studies as <48 h., two large NISC series involving over 25, 000 CES patients showed that CES surgery performed within 0 -< 24 h resulted in the best outcomes. |
format | Online Article Text |
id | pubmed-8986648 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Scientific Scholar |
record_format | MEDLINE/PubMed |
spelling | pubmed-89866482022-04-07 Review/Perspective: Operations for Cauda Equina Syndromes - “The Sooner the Better” Epstein, Nancy E. Surg Neurol Int Review Article BACKGROUND: Although most studies recommended that early surgery for cauda equina syndromes (CES) be performed within <48 h., the largest and most comprehensive Nationwide Inpatient Sample Database (NISC) series, involving over 25,000 CES patients recommended that time be shortened to 0–<24 h. In short, CES surgery performed “the sooner the better,” was best. METHODS: The 2 major variants of CES include; incomplete/partial ICES, and those with urinary retention/bowel incontinence (RCES). Those with ICES often exhibit varying combinations of motor weakness, sensory loss (i.e. including perineal numbness), and urinary dysfunction, while RCES patients typically exhibit more severe paraparesis, sensory loss including saddle anesthesia, and urinary/bowel incontinence. The pathology responsible for ICES/RCES syndromes may include; acute disc herniations/stenosis, trauma (i.e. including iatrogenic/ surgical hematomas etc.), infections, abscesses, and other pathology. Surgery for either ICES/RCES may include decompressions to multilevel laminectomies/fusions. RESULTS: Following early surgery, most studies showed that ICES and RCES patients exhibited improvement in motor weakness and sensory loss. However, recovery of sphincter function was more variable, being poorer for RCES patients with preoperative urinary retention/bowel incontinence. CONCLUSIONS: Although early CES surgery was defined in most studies as <48 h., two large NISC series involving over 25, 000 CES patients showed that CES surgery performed within 0 -< 24 h resulted in the best outcomes. Scientific Scholar 2022-03-25 /pmc/articles/PMC8986648/ /pubmed/35399881 http://dx.doi.org/10.25259/SNI_170_2022 Text en Copyright: © 2022 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Review Article Epstein, Nancy E. Review/Perspective: Operations for Cauda Equina Syndromes - “The Sooner the Better” |
title | Review/Perspective: Operations for Cauda Equina Syndromes - “The Sooner the Better” |
title_full | Review/Perspective: Operations for Cauda Equina Syndromes - “The Sooner the Better” |
title_fullStr | Review/Perspective: Operations for Cauda Equina Syndromes - “The Sooner the Better” |
title_full_unstemmed | Review/Perspective: Operations for Cauda Equina Syndromes - “The Sooner the Better” |
title_short | Review/Perspective: Operations for Cauda Equina Syndromes - “The Sooner the Better” |
title_sort | review/perspective: operations for cauda equina syndromes - “the sooner the better” |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8986648/ https://www.ncbi.nlm.nih.gov/pubmed/35399881 http://dx.doi.org/10.25259/SNI_170_2022 |
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