| Timing of surgery in cauda equina syndrome with urinary retention: meta-analysis of observational studies. | |
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MedLine Citation:
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PMID: 18377315 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECT: The authors performed exploratory meta-analyses of observational cohort studies, evidence level III, examining whether earlier surgery makes a difference in outcome in terms of urinary function once cauda equina syndrome (CES) from a herniated lumbar disc has progressed to urinary retention (CESR). METHODS: Literature search identified 27 studies of CESR patients with clear definition of surgical timing. Relative risk (RR) could not be calculated in 11 studies, leaving 16 for meta-analysis. Urinary retention related to surgical timing at 5 breakpoints: 12, 24, 36, 48, or 72 hours. Urinary outcome was classified as Normal, Fair, or Poor. Meta-analysis was performed for "Event = Fair/Poor" or "Event = Poor." Eight studies allowed separation into CESR and incomplete CES (CESI), and 5 of these had enough data for meta-analysis to compare CESR and CESI. A random effects meta-analysis model was used because of heterogeneity across the studies. A best-evidence synthesis was performed for the 4 largest studies that had 24- and 48-hour breakpoints. RESULTS: For "Event = Fair/Poor," meta-analyses using the 5 breakpoints predicted a more likely Fair/Poor outcome for later surgery (RR range 1.77-2.19). The RR for later timing of surgery was statistically significant for 24-and 72-hour breakpoints and was elevated but not statistically significant for the other 3. For "Event = Poor," the RR range was 1.09-5.82, statistically significant for the 36 hour breakpoint only. Meta-analysis comparing CESR patients with CESI patients predicted a Fair/Poor result for CESR (RR 2.58, 95% confidence interval 0.59-11.31). The best-evidence synthesis did not disclose reasons for differences in the results of the 4 studies. CONCLUSIONS: This study supports early surgery for CES and indicates that CESR and CESI cases should not be analyzed together. |
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Authors:
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W Bradford DeLong; Nayak Polissar; Blazej Neradilek |
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Publication Detail:
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Type: Journal Article; Meta-Analysis |
Journal Detail:
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Title: Journal of neurosurgery. Spine Volume: 8 ISSN: 1547-5654 ISO Abbreviation: - Publication Date: 2008 Apr |
Date Detail:
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Created Date: 2008-04-01 Completed Date: 2008-06-03 Revised Date: 2009-07-15 |
Medline Journal Info:
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Nlm Unique ID: 101223545 Medline TA: J Neurosurg Spine Country: United States |
Other Details:
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Languages: eng Pagination: 305-20 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, University of California San Francisco, California, USA. wbdelong@verizon.net |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Cohort Studies Humans Polyradiculopathy / complications*, surgery* Time Factors Treatment Outcome Urinary Retention / etiology* |
| Comments/Corrections | |
Comment In:
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J Neurosurg Spine. 2009 Jul;11(1):90-1; author reply 91-2
[PMID:
19569949
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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