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2016 ; 7
(ä): 17
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Urgent discectomy: Clinical features and neurological outcome
#MMPMID26958423
Albert R
; Lange M
; Brawanski A
; Schebesch KM
Surg Neurol Int
2016[]; 7
(ä): 17
PMID26958423
show ga
BACKGROUND: To evaluate the clinical features and outcome of patients with
progressive neurological deficits due to disc herniation who were treated
surgically within 24 h. METHODS: We conducted a retrospective analysis of
consecutive patients who were admitted between 2004 and 2013 via the Emergency
Department. Records were screened for presenting symptoms, neurological status at
admission, discharge, and 6-week follow-up. RESULTS: About 72 of 526 patients
underwent surgery within 24 h. Magnetic resonance imaging showed lumbar disc
herniation in 72 patients. The most common presenting symptoms included
radiculopathy (n = 69), the Lasègue sign (n = 60), sensory deficits (n = 57), or
motor deficits (n = 47). In addition, 11 patients experienced perineal numbness
and 12 had bowel and bladder dysfunction. At discharge, motor and sensory
deficits and bowel and bladder dysfunction had improved significantly (P < 0.001,
P = 0.029, and P = 0.015, respectively). CONCLUSION: Motor deficits, sensory
deficits, and cauda equina dysfunction were significantly improved immediately
after urgent surgery. After 6 weeks, motor and sensory deficits were also
significantly improved compared to the neurological status at discharge. Thus, we
advocate immediate surgery of disc herniation in patients with acute onset of
motor deficits, perineal numbness, or bladder or bowel dysfunction indicative of
cauda equina syndrome.