Time to Surgery and Outcomes in Cauda Equina Syndrome

An Analysis of 45 Cases

Mohamad Bydon, Joseph A. Lin, Rafael De La Garza-Ramos, Mohamed MacKi, Thomas Kosztowski, Daniel M. Sciubba, Jean Paul Wolinsky, Timothy F. Witham, Ziya L. Gokaslan, Ali Bydon

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)110-115
Number of pages6
JournalWorld Neurosurgery
Volume87
DOIs
StatePublished - Mar 1 2016

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Polyradiculopathy
Lower Extremity
Urinary Bladder
Anesthesia
Medical Records
Leg
Logistic Models
Prospective Studies
Pain

Keywords

  • 24 hour
  • 48 hour
  • Cauda equina
  • Cauda equina syndrome
  • Spine
  • Time to surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Bydon, M., Lin, J. A., De La Garza-Ramos, R., MacKi, M., Kosztowski, T., Sciubba, D. M., ... Bydon, A. (2016). Time to Surgery and Outcomes in Cauda Equina Syndrome: An Analysis of 45 Cases. World Neurosurgery, 87, 110-115. https://doi.org/10.1016/j.wneu.2015.12.054

Time to Surgery and Outcomes in Cauda Equina Syndrome : An Analysis of 45 Cases. / Bydon, Mohamad; Lin, Joseph A.; De La Garza-Ramos, Rafael; MacKi, Mohamed; Kosztowski, Thomas; Sciubba, Daniel M.; Wolinsky, Jean Paul; Witham, Timothy F.; Gokaslan, Ziya L.; Bydon, Ali.

In: World Neurosurgery, Vol. 87, 01.03.2016, p. 110-115.

Research output: Contribution to journalArticle

Bydon, M, Lin, JA, De La Garza-Ramos, R, MacKi, M, Kosztowski, T, Sciubba, DM, Wolinsky, JP, Witham, TF, Gokaslan, ZL & Bydon, A 2016, 'Time to Surgery and Outcomes in Cauda Equina Syndrome: An Analysis of 45 Cases', World Neurosurgery, vol. 87, pp. 110-115. https://doi.org/10.1016/j.wneu.2015.12.054
Bydon M, Lin JA, De La Garza-Ramos R, MacKi M, Kosztowski T, Sciubba DM et al. Time to Surgery and Outcomes in Cauda Equina Syndrome: An Analysis of 45 Cases. World Neurosurgery. 2016 Mar 1;87:110-115. https://doi.org/10.1016/j.wneu.2015.12.054
Bydon, Mohamad ; Lin, Joseph A. ; De La Garza-Ramos, Rafael ; MacKi, Mohamed ; Kosztowski, Thomas ; Sciubba, Daniel M. ; Wolinsky, Jean Paul ; Witham, Timothy F. ; Gokaslan, Ziya L. ; Bydon, Ali. / Time to Surgery and Outcomes in Cauda Equina Syndrome : An Analysis of 45 Cases. In: World Neurosurgery. 2016 ; Vol. 87. pp. 110-115.
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abstract = "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.",
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