J Korean Soc Spine Surg.  2011 Jun;18(2):57-63.

Clinical Outcome Based Cauda Equina Syndrome Scoring System for Prediction of Prognosis

• Yang JY
• Lee JK
• Song HS
• Joo YB
• Cha SM

Abstract

STUDY DESIGN: This is a retrospective study.
OBJECTIVES
We made a scoring system using the symptoms of cauda equina syndrome(CES) and we studied the efficacy of the scoring system. SUMMARY OF THE LITERATURE REVIEW: There has been no definite scoring system with clear factors that can predict the clinical results of cauda equine syndrome.
MATERIALS AND METHODS
Between 1998 and 2006, 21 patients who were diagnosed with CES and who were followed for more than 2 years were enrolled in this study. There were 6 cases of HIVD, 6 cases of degenerative spondylosis, 7 cases of vertebral fracture and 2 cases of metastatic spinal tumor. We made a scoring system for CES (SSCES) using 8 symptoms among the general clinical manifestations that accompany CES, which are low back pain, sciatic neuropathy, sensory and motor disorder of the lower extremities, loss of a saddle sensation, voiding difficulty, disorder of the anal sphincter tone and deep tendon reflex disorder.
RESULTS
The last clinical outcomes were 3 excellent patients, 5 good patients, 5 fair patients and 8 poor patients. The mean preoperative SSCES was 11.7+/-2.8(7-16) and the mean final follow up score was 7.6+/-3.4(2-13). Eight cases that had a mean preoperative SSCES score of 6 or below showed good clinical results with a mean SSCES of 3.9+/-11(2-5) on the final follow up, and 13 cases with a mean preoperative SSCES score of 7 or above showed bad clinical results with a mean SSCES of 9.9+/-1.9(7-13) on the final follow up.
CONCLUSIONS
The prognosis was better on the final follow up for the patients with a lowere preoperative SSCES. So, for the treatment of CES, preoperative evaluation using the SSCES is thought to be very useful for predicting the prognosis.

Keyword

Cauda equina syndrome; Prognostic factor; Scoring system

MeSH Terms

Anal Canal
Cauda Equina
Follow-Up Studies
Humans
Low Back Pain
Lower Extremity
Polyradiculopathy
Prognosis
Reflex, Stretch
Retrospective Studies
Sciatic Neuropathy
Sensation
Spondylosis

Figure

• 

  Fig. 1. Correlation between the preoperative and the last followup score according to the SSCES is like this.

Reference

1. Ahn BW, Kim Ck, Yoon JH, Kim KH, Lee JH, Lee EC. Cauda Equina Syndrome due to Epidural Hematoma after Lumbar Epidural Block. J Korean Soc Spine Surg. 2009; 16:134–37.

2. Aho AJ, Auranen A, Pesonen K. Analysis of cauda equina symptoms in patients with lumbar disc prolapse. Preoperative and followup clinical and cystometric studies. Acta Chir Scand. 1969; 135:413–20.

3. Ashton IK, Roberts S, Jaffray DC, Polak JM, Eisenstein SM. Neuropeptides in the human intervertebral disc. J Orthop Res. 1994; 12:186–92.

4. Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine (Phila Pa 1976). 2000; 25:1515–22.

5. Jalloh I, Minhas P. Delays in the treatment of cauda equina syndrome due to its variable clinical features in patients presenting to the emergency department. Emerg Med J. 2007; 24:33–4.

6. Shephard RH. Diagnosis and prognosis of cauda equina syndrome produced by protrusion of lumbar disk. Br Med J. 1959; 2:1434–9.

7. Kostuik JP, Harrington I, Alexander D, Rand W, Evans D. Cauda equina syndrome and lumbar disc herniation. J Bone Joint Surg Am. 1986; 68:386–91.

8. Shapiro S. Medical realities of cauda equina syndrome secondary to lumbar disc herniation. Spine (Phila Pa 1976). 2000; 25:348–51.

9. Gleave JR, Macfarlane R. Cauda equina syndrome: what is the relationship between timing of surgery and outcome? Br J Neurosurg. 2002; 16:325–8.

10. Kostuik JP. Medicolegal consequences of cauda equina syndrome: an overview. Neurosurg Focus. 2004; 16:E8.

11. Cs-Szabo G, Ragasa-San Juan D, Turumella V, Masuda K, Thonar EJ, An HS. Changes in mRNA and protein levels of proteoglycans of the anulus fibrosus and nucleus pulposus during intervertebral disc degeneration. Spine (Phila Pa 1976). 2002; 27:2212–9.

12. McLaren AC, Bailey SI. Cauda equina syndrome: a complication of lumbar discectomy. Clin Orthop Relat Res. 1986; 204:143–9.

13. Byrne TN. Disorders of the spinal cord and cauda equina. Curr Opin Neurol Neurosurg. 1993; 6:545–8.

14. Olmarker K, Rydevik B, Nordborg C. Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equina nerve roots. Spine (Phila Pa 1976). 1993; 18:1425–32.

15. Delamarter RB, Sherman JE, Carr JB. 1991 Volvo Award in experimental studies. Cauda equina syndrome: neurologic recovery following immediate, early, or late decompression. Spine (Phila Pa 1976). 1991; 16:1022–9.

16. Orendacova J, Cizkova D, Kafka J, et al. Cauda equina syndrome. Prog Neurobiol. 2001; 64:613–37.

17. Cho YH, Chang SA, Park JY, Han JH, Shin JH. Posterior Epidural Migration of a Sequestrated Intervertebral lumbar disc with Cauda Equina Syndrome. J Korean Soc Spine Surg. 2008; 15:277–80.

18. Kim HT, Hong SM, Lee KI, Jung JW, Park YM. Cauda Equina Syndrome in the Lumbar disc Herniation. J Korean Soc Spine Surg. 1998; 5:116–21.

19. Franson RC, Saal JS, Saal JA. Human disc phospholipase A2 is inflammatory. Spine (Phila Pa 1976). 1992; 17(Suppl 6):129–32.

20. Nachemson A. Intradiscal measurements of pH in patients with lumbar rhizopathies. Acta Orthop Scand. 1969; 40:23–42.

21. Saal JS, Franson RC, Dobrow R, Saal JA, White AH, Gold-thwaite N. High levels of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine (Phila Pa 1976). 1990; 15:674–8.

22. Wagner R, Myers RR. Endoneurial injection of TNF-alpha produces neuropathic pain behaviors. Neuroreport. 1996; 7:2897–901.

23. Lundborg G. Structure and function of the intraneural mi-crovessels as related to trauma, edema formation, and nerve function. J Bone Joint Surg Am. 1975; 57:938–48.

24. Yoshizawa H, Kobayashi S, Hachiya Y. Blood supply of nerve roots and dorsal root ganglia. Orthop Clin North Am. 1991; 22:195–211.

25. Schonstrom N, Bolender NF, Spengler DM, Hansson TH. Pressure changes within the cauda equina following con-striction of the dural sac. An in vitro experimental study. Spine (Phila Pa 1976). 1984; 9:604–7.

26. McCarthy MJ, Aylott CE, Grevitt MP, Hegarty J. Cauda equina syndrome: factors affecting longterm functional and sphincteric outcome. Spine (Phila Pa 1976). 2007; 32:207–16.

27. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000; 25:2940–52.

28. Grevitt M, Khazim R, Webb J, Mulholland R, Shepperd J. The short form-36 health survey questionnaire in spine surgery. J Bone Joint Surg Br. 1997; 79:48–52.

29. Holt AE, Shaw NJ, Shetty A, Greenough CG. The reliability of the Low Back Outcome Score for back pain. Spine (Phila Pa 1976). 2002; 27:206–10.

30. Bartels RH, de Vries J. Hemi-cauda equina syndrome from herniated lumbar disc: a neurosurgical emergency? Can J Neurol Sci. 1996; 23:296–9.