Influence of timing of surgery on Cauda equina syndrome: Outcomes at a tertiary care centre in North-India

Background: Acute cauda equina syndrome (CES) is a devastating emergency; the clinicians need to be aware of this entity for early diagnosis and prompt referral to the neurosurgical facility. Objectives: To study the clinical profile, management and outcome of acute CES in patients referred to a tertiary care hospital. Study Design: Prospective, Cohort Study Material and Methods: 29 patients referred with a diagnosis of acute CES were studied prospectively. The workup of all the patients included a detailed history, clinical examination, biochemical investigations, and imaging studies. An MRI scan was done in all cases. The details of surgical management and its outcome on follow-up were noted. The outcome was divided into good and bad on the basis of presence or absence of significant motor deficit, and the need for assistance incomplete bladder emptying. Standard methods of statistical analysis were used, a p-value of <0.05 was considered statistically significant. Results: A good outcome was observed in 16 patients (55%) while the remaining 13 patients (45%) had a poor outcome after the surgical intervention. The patients who had unilateral symptoms and those who were operated within 3 days of the onset of symptoms had a better outcome than those operated later (p <0.05). Of all the prognostic factors studied, motor deficit at presentation was observed to be significantly related to poor outcome after surgery. Conclusion: Acute CES is a devastating clinical entity with nearly half of the patients having a poor outcome. In patients presenting with clinical involvement of a lesser magnitude, a better outcome is observed with early surgery