Ahn cauda equina meta-analysis

Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes

Ahn UM, Ahn NU, Buchowski JM, et al. Spine 2000 · PMID 10851100 · doi:10.1097/00007632-200006150-00010

Question

Does the timing of decompression after onset of cauda equina syndrome from disc herniation affect outcome?

Design

Meta-analysis of published case series (42 studies) reporting surgical outcomes of cauda equina syndrome.

Patients

Patients undergoing surgical decompression for cauda equina syndrome secondary to lumbar disc herniation.

Intervention

Decompression within 48 hours of onset

Comparison

Decompression after 48 hours

Primary outcome

Recovery of sensory, motor, urinary, rectal and sexual function

Key result

Decompression within 48 hours was associated with significantly better recovery of sensory and motor deficits and urinary and rectal function than later surgery, with no extra gain from operating within 24 hours versus 24-48 hours; pre-existing chronic back pain and rectal dysfunction were associated with worse sphincter outcomes.

Limitations

Based on heterogeneous retrospective case series with no distinction between incomplete and retention syndromes, so causation cannot be inferred.

Impact on practice

Frequently cited as the basis for urgent decompression in cauda equina syndrome; current UK pathways go further and expect emergency MRI and surgery without delay.