Clinical Research Of The Cauda Equina Syndrome Secondary To Lumbar Disc Herniation

Objective:The study is to investigate the mechanism and the clinical features of cauda equina syndrome (CES) secondary to lumbar disc herniation (LDH), and to determine the post-operation therapeutic effects resulting from different timing of surgery and different surgical approach.Methods:With a retrospective analysis of 53 patients underwent operation with CES secondary to LDH respectively. The clinical symptoms, timing of operations, approaches and results of the 53 cases were analyzed comprehensively.Results:There is no spectacular difference existing on different clinical types. In the acute CES secondary to LDH patients'group, the study showed no statistical difference on therapeutic effects between the patients underwent operation within 24h and within 48h. However, patients within 48h received a significantly greater therapeutic effect from surgery than the group more than 48h. Surgical outcome showed no statistical difference on the therapeutic effects between the acute and the chronic patients'group. Surgical outcome showed the patients underwent "all lamina cutting" received better rehabilitation than those underwent "intervertebral space" or "hemi-lamina cutting". Surgical outcome showed no statistical difference on the therapeutic effects between the patients with internal fixation and the patients without internal fixation.Conclusion:Delayed diagnosis and management of LDH secondary to CES would cause the serious adverse consequence. In clinical practice, acurate distinguishing the complete and uncomplete cauda equina injury should be a essential therapetic precaution. MRI scan has imcompetent advantages on making the diagnosis, verifying the pathological changes and proposing the surgical plan. Being effective on the decompression and releasing adhesion, operation should be the primary choice of managements on LDH secondary to CES. Internal fixation was not necessarily respond to a better clinical effect. However, internal fixation could enhance the post-operational stability and decrease possiblity of LDH recurrence. Therefore, internal fixation should be advisable if objective conditions permitted.