TY - JOUR
T1 - Time to Surgery and Outcomes in Cauda Equina Syndrome
T2 - An Analysis of 45 Cases
AU - Bydon, Mohamad
AU - Lin, Joseph A.
AU - De La Garza-Ramos, Rafael
AU - MacKi, Mohamed
AU - Kosztowski, Thomas
AU - Sciubba, Daniel M.
AU - Wolinsky, Jean Paul
AU - Witham, Timothy F.
AU - Gokaslan, Ziya L.
AU - Bydon, Ali
N1 - Funding Information:
Conflict of interest statement: Ali Bydon is the recipient of a research grant from Depuy Spine; He serves on the clinical advisory board of MedImmune, LLC. Daniel Sciubba is the recipient of a research grant from Depuy Spine; he has consulting relationships with Medtronic, Nuvasiv, Globus, and Depuy Spine. Timothy Witham is the recipient of a research grant from Eli Lilly & Co and The Gordon & Marilyn Macklin Foundation. Ziya Gokaslan is the recipient of research grants from Depuy Spine, AO Spine North America, Medtronic, NREF, Integra Life Sciences, and K2M; he receives fellowship support from AO Spine North America; and he holds stock in Spinal Kinetics and US Spine.
Funding Information:
Ali Bydon is the recipient of a research grant from Depuy Spine; He serves on the clinical advisory board of MedImmune, LLC. Daniel Sciubba is the recipient of a research grant from Depuy Spine; he has consulting relationships with Medtronic, Nuvasiv, Globus, and Depuy Spine. Timothy Witham is the recipient of a research grant from Eli Lilly & Co and The Gordon & Marilyn Macklin Foundation. Ziya Gokaslan is the recipient of research grants from Depuy Spine, AO Spine North America, Medtronic, NREF, Integra Life Sciences, and K2M; he receives fellowship support from AO Spine North America; and he holds stock in Spinal Kinetics and US Spine.
Publisher Copyright:
© 2016 Elsevier Inc. All rights reserved.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Objective The objective of this study is to analyze time to surgery as both a continuous and discrete variable to determine its association with outcomes in cauda equina syndrome (CES). Methods Patients at a single center whose medical record allowed precise calculation of time to surgery were included. CES was defined as at least four of the following: bladder dysfunction, saddle anesthesia, lower extremity weakness, lower extremity sensory disturbance, bowel dysfunction, or acute lower back or leg pain. Time to surgery was analyzed as a continuous variable using logistic and ordered logistic regression, and as a discrete variable by comparing patients treated before and after set thresholds. Results Forty-five patients were identified. Analysis of time as a continuous variable did not reveal any significant association with outcomes. A parsimonious model with adjustment for age, sex, race, acute onset of CES, saddle anesthesia, motor deficit, and bowel dysfunction at presentation was used to analyze the continuous influence of time to surgery on bladder dysfunction and an aggregate outcome of symptoms. Neither time to surgery nor any of the covariates were significantly associated with either outcome. Discrete analysis of outcomes across thresholds of 12, 24, 36, 48, 60, and 72 hours did not reveal prognostic time points. Conclusion In this single-center CES series, time to surgery did not have a convincing continuous or discrete relationship with outcome. Future prospective studies are needed to determine the best timing for surgery in patients with CES.
AB - Objective The objective of this study is to analyze time to surgery as both a continuous and discrete variable to determine its association with outcomes in cauda equina syndrome (CES). Methods Patients at a single center whose medical record allowed precise calculation of time to surgery were included. CES was defined as at least four of the following: bladder dysfunction, saddle anesthesia, lower extremity weakness, lower extremity sensory disturbance, bowel dysfunction, or acute lower back or leg pain. Time to surgery was analyzed as a continuous variable using logistic and ordered logistic regression, and as a discrete variable by comparing patients treated before and after set thresholds. Results Forty-five patients were identified. Analysis of time as a continuous variable did not reveal any significant association with outcomes. A parsimonious model with adjustment for age, sex, race, acute onset of CES, saddle anesthesia, motor deficit, and bowel dysfunction at presentation was used to analyze the continuous influence of time to surgery on bladder dysfunction and an aggregate outcome of symptoms. Neither time to surgery nor any of the covariates were significantly associated with either outcome. Discrete analysis of outcomes across thresholds of 12, 24, 36, 48, 60, and 72 hours did not reveal prognostic time points. Conclusion In this single-center CES series, time to surgery did not have a convincing continuous or discrete relationship with outcome. Future prospective studies are needed to determine the best timing for surgery in patients with CES.
KW - 24 hour
KW - 48 hour
KW - Cauda equina
KW - Cauda equina syndrome
KW - Spine
KW - Time to surgery
UR - http://www.scopus.com/inward/record.url?scp=84960079759&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84960079759&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2015.12.054
DO - 10.1016/j.wneu.2015.12.054
M3 - Article
C2 - 26724637
AN - SCOPUS:84960079759
SN - 1878-8750
VL - 87
SP - 110
EP - 115
JO - World Neurosurgery
JF - World Neurosurgery
ER -