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Surgery within 48 hours of cauda equina syndrome onset not clinically relevant, study finds

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SAN FRANCISCO — Although it is fairly common practice to surgically treat patients with cauda equina syndrome within 48 hours of when they present with the condition, a retrospective study presented at the American Association of Neurological Surgeons, here, found no differences in outcomes for patients when investigators looked at time to surgery as a continuous variable, ordinally and as a discrete variable.

“Symptoms at presentation tended to be the number one impact on symptoms at last follow-up, and the number of symptoms at presentation tended to be the largest impact on number of symptoms at last follow-up,” Mohamad Bydon, FAANS, a sixth-year resident in neurosurgery at Johns Hopkins Hospital, in Baltimore, said.

According to Bydon, the 48 consecutive patients who were included in the study had a mean age of 40 years and had discogenic cauda equina syndrome (CES) verified by MRI findings and had medical records that could be accessed to allow the time to surgery to be accurately calculated. Forty-two patients had CES retention and 6 patients had incomplete CES.

Bringing some patients to the operating room sooner than 48 hours from presentation — early treatment — resulted in no added benefit that was reflected in outcomes, according to the study abstract.

Bydon said his institution still adheres to the 48-hour rule for surgery in these cases but noted it is due to medico-legal implications more than evidence-based medicine. He cited a study by Daniels and colleagues that reviewed 15 lawsuits on cauda equina.

“They found a mean of $1.57 million more likely awarded to the plaintiff for surgeries delayed beyond 48 hours. Persistent neurological dysfunction did not impact the plaintiff award. So regardless of how a patient actually does, the time that you take them to surgery seems to be what the jurors care about.” – by Susan M. Rapp

Reference:

Bydon M. Paper #619. Presented at: American Association of Neurological Surgeons Annual Meeting; April 5-9, 2014; San Francisco.

Disclosure: Bydon has no relevant financial disclosures.