Cauda Equina Syndrome: Poor Recovery Prognosis Despite Early Treatment

Alexia Planty-Bonjour, MD; Gaelle Kerdiles, MD; Patrick François, MD, PhD; Christophe Destrieux, MD, PhD; Stephane Velut, MD, PhD; Ilyess Zemmoura, MD, PhD; Ann-Rose Cook, MD; Louis-Marie Terrier, MD; Aymeric Amelot, MD, PhD


Spine. 2022;47(2):105-113. 

In This Article

Materials and Methods

Ethics Statement

The protocol can be found in the reference methodology MR003 chapter adopted by the CNIL to which the University Hospitals of Tours conform.

Study Population

A prospective database of 140 consecutive patients operated for CES between January 2010 and 2019 was generated from the Neurosurgery Department. All patients underwent diagnostic and preoperative imaging before the extraction of the herniated lumbar disc responsible for the CES.

Clinical Symptom Evaluation

Motor deficits were graded on a scale of 0 to 5 according to the Medical Research Council scale for muscle strength.[16] Sensitive deficits were also evaluated according to the Medical Research Council scale, with "0" representing disappearance, "1" altered, and "2" normal sensitivity.[16] Bowel dysfunctions were evaluated during the FU with the neurogenic bowel dysfunction (NBD) score[17] and bladder dysfunctions were defined by the Urinary symptoms Profile.[18] The genital dysfunctions were collected at clinical examination: saddle anesthesia and interrogation about sexual dysfunction (erectile dysfunction or vaginal dryness).

Statistical Analyses

All tests were two-sided; P values < 0.05 were considered statistically significant. Univariate and multivariate Cox proportional hazard regression models were conducted using SPSS software, version 22.0 (SPSS, Chicago, IL). Establishment and verification of nomograms were implemented using the open source software R-version 3.2.5 with rms packages (Design, Vienna, Austria). Data are presented as the mean/median ± standard deviation. The distribution of categorical variables was described with frequencies and percentages, whereas continuous and normally distributed variables were described with means and standard deviations (SD). In the univariate analysis, categorical variables were assessed using Pearson Chi-square or Fisher exact test. The multivariate analysis was conducted separately for each diagnosis and the Cox proportional hazards model was used to estimate hazard ratios and 95% confidence intervals (CIs). The output was expressed as odds ratios and their bootstrapped 95% CIs. The Kaplan–Meier method was used to estimate the metastases free survival? For descriptive and inferential analyses, boot-strapping with replacement (iterations = 1000) was performed to attain variance estimates at the 95% CI.