Decompression vs. Decompression and Fusion in Cauda Equina Syndrome Secondary to Massive Lumbar Disc Herniation
Abstract
Posterior spinal surgery through either a decompression or additional fusion procedure is the widely accepted standard of care for patients presenting with cauda equina syndrome (CES) secondary to massive disc herniation. A plethora of literature has been published regarding post- surgical outcome, particularly in regards to improvement of lower sacral nerve symptoms in relation to timing of surgery. There is a paucity of data with regards to long term clinical outcomes in patients between the decompression and decompression and fusion groups. We initially hypothesized was that there would be no longer term clinical differences in outcome between the two groups, which was the objective of this thesis. The initial post-operative data showed no statistically significant difference between the decompression and fusion groups with regards to lower extremity weakness, presence of radicular symptoms, and improvement in lower sacral symptoms, those being bladder, bowel, and sexual function. Our long-term follow up cohort yielded patients the decompression group alone and showed general trends of improvement from their initial presentation in the aforementioned domains.