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The Journal of Bone and Joint Surgery, Vol 68, Issue 3 386-391, Copyright © 1986 by Journal of Bone and Joint Surgery, Inc
Cauda equina syndrome and lumbar disc herniation
JP Kostuik, I Harrington, D Alexander, W Rand and D Evans
In a retrospective chart review of the cases of thirty-one patients with
cauda equina syndrome secondary to a central disc lesion, we identified two
modes of presentation. The first was an acute mode (ten patients) in which
there were abrupt, more severe symptoms and signs and a slightly poorer
prognosis after decompression, especially for the return of bladder
function. The second mode of presentation (twenty-one patients) was a
slower onset, characterized by prior symptoms for varying time-intervals
before the more gradual onset of the cauda equina syndrome. All patients
had urinary retention preoperatively. Bladder function was the most
seriously affected function preoperatively and remained so postoperatively.
The prognosis for return of motor function was good, since twenty-seven of
the thirty patients who were operated on regained normal motor function.
Preoperatively all patients had sciatica, which was bilateral in fourteen
and unilateral in seventeen. The average time to surgical decompression
after the patient was seen ranged from 1.1 days for the more acute lesions
to 3.3 days for the second group. There was no correlation of these times
with return of function. Therefore, even though early surgery is
recommended, decompression does not have to be performed in less than six
hours if recovery is to occur, as has been suggested in the past.
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