RF30#289
Rapid Fire
Delayed (>48 Hours) Posterior Wide Decompression in Complete Cauda Equina Syndrome: A 30-Patient Retrospective Cohort With 24-Month Outcomes
Shaikh Islam¹, Dr Shirajum Munira Mou², Dr AKM Rafiqul Islam³, Dr Afroza Akter Bithi⁴, Nosibul Hasan Naiem⁵
¹ Assistant Professor, Spine Surgery, National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh ² Department of Orthopaedics, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh ³ Department of Spine Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh ⁴ Dhaka Dental College, Dhaka, Bangladesh ⁵ Dinajpur Medical College, Dinajpur, Bangladesh
Background: Cauda equina syndrome (CES) requires urgent decompression to optimize neurological recovery. However, delayed presentation beyond 48 hours is common in real-world settings. The effectiveness of delayed surgery in complete CES remains unclear, particularly for long-term outcomes.
Purpose: To evaluate neurological and autonomic recovery at 24 months following delayed (>48 hours) posterior decompression in patients with complete CES.
Study Design/Setting: Retrospective cohort study at a tertiary referral center (2016–2025). Patient Sample Thirty patients (age 20–70 years) with radiologically confirmed lumbar disc herniation and clinically diagnosed complete CES (urinary retention ± saddle anesthesia), all undergoing decompression >48 hours after symptom onset with minimum 24-month follow-up. Outcome Measures Bladder, bowel, and sexual function; motor recovery (MRC grading); sensory improvement; and complications.
Methods: All patients underwent posterior wide decompression via standard midline approach. Descriptive statistics were used, with proportions reported alongside 95% confidence intervals.
Results: At 24 months Motor recovery 73.3%, Sensory improvement 66.7%, Bladder dysfunction 40.0%, Bowel dysfunction 20.0% Sexual dysfunction 76.7%, Complications occurred in 13.3% (SSI 6.7%, discitis 3.3%, secondary fusion 3.3%), with no mortality. All patients demonstrated neurological improvement. Increasing age correlated with poorer sexual recovery.
Conclusions: Delayed decompression (>48 hours) in complete CES allows meaningful neurological recovery, particularly in motor and bowel function. However, sexual dysfunction remains highly prevalent. While early surgery remains the standard, delayed intervention still provides significant clinical benefit.
