Special Poster Session 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Dural Sac Cross-Sectional Area Measurement for Predicting Cauda Equina Syndrome in Lumbar Disc Herniation Patients (#SP-3f)

Su-Il Jung 1 , Soo-Bin Lee 1 , Kyung-Yil Kang 1
  1. Orthopaedic Surgery, Catholic Kwandong University International St.Mary's Hospital, Incheon, Republic of Korea

Introduction

Cauda equina syndrome (CES) can rarely occur due to lumbar disc herniation and may lead to severe complications such as permanent lower limb paralysis, impaired bladder and bowel control, and loss of sexual sensation. However, there has been a lack of research investigating risk factors for predicting CES in patients with lumbar disc herniation. In this study, we assessed the diagnostic value of the dural sac cross-sectional area in predicting CES in lumbar disc herniation.

 

Methods

From 2014 to 2023, 99 patients who underwent surgery for lumbar disc herniation were included and analyzed retrospectively. The dural sac cross-sectional area (DSCSA) was measured at the narrowest level of the dural sac in the axial T2-weighted magnetic resonance imaging scan. Multivariable logistic regression analysis was conducted on DSCSA and other candidate risk factors, including age, sex, and BMI.

 

Results

Among the included lumbar disc herniation patients, 9 CES patients (9.1%) were identified. In the multivariable logistic regression analysis, only DSCSA was associated with CES, with an adjusted odds ratio of 0.79 (95% confidence interval: 0.65 to 0.95, p=0.015). In the receiver operating characteristic curve analysis, an optimal cut-off value for DSCSA was 31.16 mm², yielding 100% sensitivity, 92.2% specificity, and an area under the curve of 0.974 (95% confidence interval: 0.944 to 1, p < 0.001).

 

Conclusions

There was a significant correlation between DSCSA and CES. Patients with lumbar disc herniation and a DSCSA measurement of approximately 30 mm² or less should undergo close monitoring for CES symptoms, and early surgical intervention could be beneficial in averting severe complications of CES.

 

 

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Figure 1. Representative cases for the measurement of dural sac cross-sectional area (DSCSA). (A) Lumbar disc herniation with cauda equina syndrome (CES). (B) Lumbar disc herniation without CES.

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Figure 2. Receiver operating characteristic (ROC) curve of DSCSA for the prediction of CES.