Detrusor Overactivity in Patients With Cauda Equina Syndrome

Spine (Impact Factor: 2.3). 05/2014; 39(16). DOI: 10.1097/BRS.0000000000000410
Source: PubMed


Study Design. Retrospective cross-sectional studyObjective. To delineate the neurogenic bladder type in patients with cauda equina syndrome (CES) and to suggest, in light of the clinical, radiological, and electrophysiological findings, a possible cause of bladder dysfunction.Summary of Background Data. Many patients with CES suffer from bladder dysfunction, though the type of neurogenic bladder is quite variable in the clinical setting. Bladder dysfunction in CES patients is usually areflexic or acontractile detrusor. However detrusor overactivity (DOA) also reported, which cases cannot be explained by pure root injuries in the cauda equina region.Methods. CES patients with neurogenic bladder were studied, all of whom (n = 61; mean age ± SD, 48.0±15.9y) underwent urodynamic analysis, magnetic resonance imaging (MRI), and electrophysiology. According to the urodynamic findings, the neurogenic bladder was classified into two types: DOA and detrusor underactivity or acontractility (DUA). The highest level of injury (HLI) or level of injury (LOI) was determined and analyzed on the basis of the clinical-urodynamic and electrophysiological findings, respectively.Results. Twenty CES patients (32.8%) showed DOA; in most of them (85.0%, 17/20 patients), the HLI on electrophysiological assessment was L2 or above. Forty-one CES patients showed DUA; and most of the CES patients whose highest LOI was L3 or below showed DUA (91.2%, 31/34 patients). None of the HLI or LOI from the clinical or MRI findings correlated with neurogenic bladder type. We also found that urodynamic findings including maximal detrusor pressure and bladder capacity was partially correlated with the HLI on electrophysiological assessment (r = 0.244, p<0.001 and r = 0.330; p<0.001, respectively).Conclusion. DOA was seen most often in CES patients whose highest level of injury was L2 or above, and might be associated with combined conus medullaris lesion. Electrophysiology might be the most useful assessment tool for prediction of neurogenic bladder type in CES patients.

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Available from: Jung Keun Hyun, Oct 06, 2014