Radek Kaiser1, Aneta Krajcová2, Petr Waldauf3, Nisaharan Srikandarajah4, Michal Makel5, Vladimír Beneš6. 1. Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic. Electronic address: rkaiser@hotmail.cz. 2. Department of Plastic Surgery, First Faculty of Medicine, Charles University and Hospital Bulovka, Prague, Czech Republic; Department of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic. 3. Department of Anesthesiology and Critical Care Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic. 4. Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom. 5. Department of Plastic Surgery, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic. 6. Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic.
Abstract
OBJECTIVE: Risk factors for developing cauda equina syndrome (CES) caused by lumbar disk herniation (LDH) remain controversial and have not been established yet. The aim of the study was to investigate whether there is a relationship among age, sex, body mass index (BMI), or the degree of spinal canal compromise and the presence of CES in patients undergoing lumbar microdiskectomy. METHODS: Between 2015 and 2019, 506 patients who had an operation for LDH compressing the dural sac were prospectively identified. The "prolapse-to-canal ratio" (PCR) was calculated as a proportion of the cross-sectional area of the disk prolapse compared with the total cross-sectional area of the spinal canal. RESULTS: In total, 35 CES (6.9%) patients were identified. Multivariate logistic regression, adjusted for age, gender, BMI, and PCR, shows that only PCR was associated with the presence of CES (P < 0.001, area under the curve 0.7431). BMI was not associated with an increased risk of CES. CONCLUSIONS: This study demonstrates a significant correlation between the size of LDH relative to size of the spinal canal and the presence of CES. A finding of LDH causing >60% obstruction of the spinal canal should be considered a red flag, and such patients need to be watched more closely.
OBJECTIVE: Risk factors for developing cauda equina syndrome (CES) caused by lumbar disk herniation (LDH) remain controversial and have not been established yet. The aim of the study was to investigate whether there is a relationship among age, sex, body mass index (BMI), or the degree of spinal canal compromise and the presence of CES in patients undergoing lumbar microdiskectomy. METHODS: Between 2015 and 2019, 506 patients who had an operation for LDH compressing the dural sac were prospectively identified. The "prolapse-to-canal ratio" (PCR) was calculated as a proportion of the cross-sectional area of the disk prolapse compared with the total cross-sectional area of the spinal canal. RESULTS: In total, 35 CES (6.9%) patients were identified. Multivariate logistic regression, adjusted for age, gender, BMI, and PCR, shows that only PCR was associated with the presence of CES (P < 0.001, area under the curve 0.7431). BMI was not associated with an increased risk of CES. CONCLUSIONS: This study demonstrates a significant correlation between the size of LDH relative to size of the spinal canal and the presence of CES. A finding of LDH causing >60% obstruction of the spinal canal should be considered a red flag, and such patients need to be watched more closely.