Outcomes of cauda equina syndrome due to lumbar disc herniation after surgical management and the factors affecting it: a systematic review and meta-analysis of 22 studies with 852 cases

摘要

Abstract Purpose This study aimed to investigate the long-term clinical outcomes after surgical decompression in cauda equina syndrome (CES) and see if any preoperative patient-related factors contributed to this outcome. Methods A systematic literature search was conducted in the electronic databases of PubMed, Embase, Scopus, and Ovid. Data regarding outcome parameters from eligible studies were extracted. Meta-analysis was performed using a random-effect model. Results A total of 852?patients (492 males and 360 females), with a mean age of 44.6 ± 5.5 years from 22 studies diagnosed with cauda equina syndrome and undergoing surgical decompression, were included in the meta-analysis; however, not all studies reported every outcome. The mean follow-up period was 39.2 months, with a minimum follow-up of 12 months in all included studies. Meta-analysis showed that on long-term follow-up, 43.3 29.1, 57.5 (n=708) of patients had persistent bladder dysfunction. Persistent bowel dysfunction was observed in 31.1 14.7, 47.6 (n=439) cases, sensory deficit in 53.3 37.1, 69.6 (n=519), motor weakness in 38.4 22.4, 54.4 (n=490), and sexual dysfunction in 40.1 28.0, 52.1 (n=411). Decompression within 48?hours of the onset of symptoms was associated with a favourable outcome in terms of bladder function with 24.6 1.6, 50.9 (n=75) patients having persistent dysfunction, whereas 50.3 10.3, 90.4 (n=185) of patients in studies with a mean time to decompression after 48 hours had persistent bladder dysfunction. Other factors such as speed of onset and sex of the patients were not found to significantly impact long-term bladder outcomes.Conclusion The long-term outcomes of CES after decompression are enumerated. Decompression within 48?hours of the onset of symptoms appears to result in fewer patients with persistent bladder dysfunction. However, a randomized controlled trial is required to conclusively determine whether early decompression leads to better outcomes.