Improvement in Neurogenic Bowel and Bladder Dysfunction Following Posterior Decompression Surgery for Cauda Equina Syndrome: A Prospective Cohort Study

Objective: The mechanisms of neurogenic bowel dysfunction (NBD) and neurogenic blad-der (NB), which are major consequences of spinal cord injury and occasionally degenera -tive lumbar disease. The following in patients with cauda equina syndrome who underwent posterior decompression surgery was investigated: (1) the preoperative prevalence of NBD and NB, measured using the Constipation Scoring System (CSS) and International Prostate Symptoms Score (IPSS); (2) the degree and timing of postoperative improvement of NBD and NB. Methods: We administered the CSS and IPSS in 93 patients before surgery and at 1, 3, 6, and 12 months postoperatively. We prospectively examined patient characteristics, Japa-nese Orthopaedic Association (JOA) score, and postoperative improvements in each score. Results: The prevalence of symptomatic defecation and urinary symptoms at admission were 37 patients (38.1%) and 31 patients (33.3%), respectively. Among the symptomatic patients with defecation problems, 12 patients had improved at 1 month, 13 at 3 months, 14 at 6 months, and 13 at 12 months postoperatively. Among the symptomatic patients with uri-nary problems, 5 patients improved at 1 month, 11 at 3 months, 6 at 6 months, and 10 at 1 year postoperatively. Comparing patients with improved versus unimproved in CSS, the degree of JOA score improvement was a significant prognosis factor (p < 0.05; odds ratio, 1.05). Conclusion: The prevalence of symptomatic defecation and urinary symptoms in patients with cauda equina syndrome was 38.1% and 33.3%, respectively. Decompression surgery improved symptoms in 30%-50%. These effects were first observed 1 month after the oper-ation and persisted up to 1 year.