Analysis of Cauda Equina Syndrome Patterns in Basra

Cauda equina syndrome is a perplexing problem worldwide, often leading to prolonged morbidity with unsatisfactory outcomes. This condition typically results in bladder and bowel dysfunction, as well as potential motor and/or sensory loss within the lumbar and/or sacral dermatomes. The underlying cause of this syndrome remains elusive, with various pathologies implicated. Anatomical variations may also play a role in its etiology. This study aims to analyze the underlying pathology, assess presentation patterns and prognosis, examine the relationship between presentation time, operative treatment timing, and treatment outcomes, and explore ideal treatment options. This prospective study was conducted at Basra Teaching Hospital's Orthopedic Department between September 2002 and September 2005. Forty-four patients with cauda equina syndrome were included in the study, comprising 31 males (70.5% of the total) and 13 females (29.5% of the total). The mean age of the patients was 39 years, with the youngest being 14 years old and the oldest 64 years. The majority of patients (52%) were in the 3rd and 4th decades of life. Evaluation of presenting symptoms revealed that lower limb weakness was the most common symptom, occurring in 24 patients (54.5%). Paresthesia was the least common symptom, found in only 2 patients (4.5%). The most common precipitating factors were heavy exercise (30 patients), followed by road traffic accidents, falls from a height, tumors, trauma, and manipulation. Root tension tests, including the Bowstring test, straight leg raising test, and femoral stretching test, were positive in 79.5%, 68.2%, and 9% of all patients, respectively. Neural compression was observed in a single level in 86.3% of cases, with more than one level affected in 13.7%. The most common level of compression was L4-L5 (64%), followed by L5-S1 (22.7%). Disc prolapse was the leading cause of the syndrome (69%), followed by trauma, bulging discs, tumors, and hematomas. Thirty-eight patients were treated surgically through laminectomy with or without transpedicular fixation, while six patients received conservative treatment. The duration between clinical presentation and surgery was within 72 hours for 6 patients (13.3%), resulting in a good prognosis (11.3%). Between one week and four weeks, 14 patients (31.6%) underwent surgery, with a good prognosis in 13.6% of cases. For more than one month, 24 patients (54.1%) had surgery, with a majority experiencing a poor prognosis (50%).