Peri-operative Radiological Factors Predicting Outcome of Discogenic Cauda Equina Syndrome

Abstract

Background Data: Acute cauda equina syndrome (CES) is a rare disorder considered as a neurosurgical emergency. It can be devastating in some circumstances. Outcome can be predicted by certain preoperative radiological and clinical items. Purpose: To evaluate and analyse the effect of radiological criteria either pre- or postoperative on the final outcome of acute cauda equina syndrome. Study Design: A prospective clinical case study on 27 patients who were presented by manifestations of CES from May 2014 to September 2017. Patients and Methods: Between May 2014 to May 2017 a total of 27 consecutive patients with discogenic acute cauda equina syndrome underwent decompressive surgery (laminectomy and discectomy) with a follow-up at 6 and 12 months postoperative. Preoperative and postoperative clinical assessments were done by using Visual Analogue Scale (VAS) for analysing pain and full neurological examination. Surgical outcome was assessed using Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA) scale. Recovery rate (RR) was calculated in final follow up for each patient. In all cases, preoperative and at the last follow-up control a neuro-radiographic MRI assessment was done. Level of affection, size and direction of prolapsed disc, presence of lumbar canal stenosis, degree of decompression (laminectomy), and the presence of disc residual disc, were all thoroughly analyzed with evaluating the correlation with clinical outcome. Results: At final follow-up visit, we found that radiological factors had significant effect on the overall clinical outcome. L5-S1 disc level had the most favourable outcome when compared to other affected level. A statically significant correlation was found between degree of decompression and overall clinical improvement (P=0.001). Residual disc fragments had a direct relation to incomplete recovery from preoperative symptoms although statistically insignificant (P=0.93). Conclusion: Full and thorough study of the pre- and postoperative radiological findings of the patients presented with discogenic cauda equina syndrome has an important prognostic value that can give a prediction for the surgical outcome and the overall clinical improvement. The degree of decompression and presence of canal stenosis was the most important outcome predictor factors. (2017ESJ148)

Keywords

• Cauda equine
• lumbar disc
• Radiology
• outcome