Study on Lumbar Disc Herniation with Cauda Equina Syndrome

  • Inomata Naoki
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
  • Kuroki Hiroshi
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
  • Hamanaka Hideaki
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
  • Masuda Hiroshi
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
  • Fukushima Shuichiro
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
  • Kuroki Shuji
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
  • Higa Kiyoshi
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
  • Higuchi Seiji
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
  • Nagai Takuya
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
  • Kubo Shinichiro
    Department of Orthopaedic Surgery, Koujunkai Nozakihigashi Hospital, Miyazaki, Japan
  • Chosa Etsuo
    Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

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Other Title
  • 馬尾症候群を呈した腰椎椎間板ヘルニアの検討

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Abstract

We report a study on five cases undergoing emergency surgery for lumbar disc herniation with cauda equina syndrome. The subjects (three males and two females, mean age 37 years) were reviewed for clinical picture, surgery-related items, and postoperative results. Two cases had acute onset of bladder and rectal disturbance and three had subacute. Three of the five cases were severely disabled patients with urinary retention. The duration between appearance of disturbance and surgery was two days or less in two cases and three days or more in three cases. All cases underwent surgery within 24 hours after their first visit to our hospital. Both JOA score and urinary disturbance improved. In three cases, improvement was insufficient in terms of defecation. It has been reported that it is significantly advantageous to treat patients within 48 hours versus more than 48 hours after the onset of cauda equina syndrome, and that there is significant improvement in sensory and motor deficits as well as urinary and rectal functions in patients who underwent decompression within 48 hours versus after 48 hours. It is of great clinical importance to detect not only lower-extremity symptoms but also bladder and rectal disturbance as early as possible.

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