Analysis Of Neurological Function On Patients Underwent Late Decompression With Cauda Equina Syndrome Secondary To Lumbar Disc Protrusion

BackgroundCES caused by LDP(CES-LDP)is a relatively rare situation which attributed to compression and compromise of cauda equina function by variety of causes.It significantly affect patient's health.Acute decompression is advocated to relieve the compression and give chance to retain the potential of recovery of cauda equina.But information associated further late(weeks or months delay)decompression and its long time consequences is limited.ObjectiveTo explore and analyze the neurological function on patients with CES secondary to LDP who underwent delayed decompression.Materials and methods35 patients meet the criteria were retrospectively reviewed.For a diagnosis of complete CES,one or more of the following must be present:(1)overflow incontinence and need catheterization.(2)fecal incontinence,(3)loose sensation in the saddle area,or(4)sexual dysfunction.The incomplete CES was defined as partially loss of functions with bladder,bowel or sexual activities and sensation of saddle area.We focused on the functions of bladder empty,bowel control,sexual ability,sensation of saddle area in the follow up and the function above were compared pre-and postoperatively.6 patients underwent urodynamic analysis before and after operation.ResultsPatients received surgical decompression 4.1+3.9 weeks(complete CES)or 5.5+7.6(?2 days)weeks(incomplete CES)from onset of symptoms.The follow-up time is 43.0+28.9 months(3-110 months).For 23 patients with incomplete CES,19 obtained full recovery,4 had slight alteration in saddle area or lower limbs.For 12 patients with complete CES,2 reported full recovery,4 reported slight sense alterations in saddle area or lower limbs and 2 of them have occasional constipation,6 still had sense deficit in saddle area and difficulties in bladder or bowl empty,but they reported great recovery compared to the situation before operation.In the urodynamic examination,all 6 patients were detected increased abdominal pressure when voiding and the residual urine reduced significantly;4 patients with abnormal first desire volume before operation returned to normal.ConclusionFor those unfortunate LDP-CES patients with delayed decompression,in the long time follow-up,a certain degree of functional recovery still could be expected,especially in the incomplete CES group.The recovery of bladder empty might due to restoration of bladder sensation and compensation of increased intra-abdominal pressure.The key strategy to help recovering of bladder function would be focused on detrusor recovery.