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Purpose <p>This study aimed to evaluate the prolapse to canal ratio (PCR) and its long-term impact on outcomes in cauda equina syndrome (CES).</p> Methods <p>A 5-year retrospective cohort study was conducted across two neurosurgical centers, including adult patients diagnosed with CES due to herniated lumbar discs, treated with laminectomy and/or discectomy, with available radiological data and follow-up. PCR was calculated as the proportion of the disc prolapse cross-sectional area to the total spinal canal area. MRI scans were independently analyzed by two investigators, with random verification by a third. Patient demographics, symptoms, treatment, and follow-up data were also collected.</p> Results <p>Among 137 patients, cohorts were divided using a PCR cut-off of 0.5. Patients with PCR &gt; 0.5 were significantly more likely to have persistent symptoms at follow-up (OR 3.93, CI 2.25–7.34, <i>p</i> &lt; 0.0001). This risk increased with higher PCR thresholds (&gt; 0.75 and &gt; 0.8). PCR &gt; 0.5 also predicted a greater likelihood of requiring a full laminectomy over minimally invasive approaches (OR 2.14, 95% CI 1.3–3.6, <i>p</i> &lt; 0.005). Lower PCR (&lt; 0.5) was associated with reduced complication rates and shorter hospital stays.</p> Conclusions <p>PCR is a valuable predictor of persistent pain and functional deficits following CES surgery and could be used to guide patient counseling before surgical intervention.</p>

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The impact of prolapse to canal ratio (PCR) in cauda equina syndrome outcomes and operative management

  • 期刊论文

  • 发表日期：

    2025年4月2日

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  • Asfand Baig Mirza,
  • Feras Fayez,
  • Sami Rashed,
  • Ammal Bibi Shahid,
  • Chaitanya Sharma,
  • Rishabh Suvarna,
  • Amisha Vastani,
  • Ahmed Serag,
  • Ali Nader-Sepahi,
  • Alexander Montgomery,
  • Irfan Malik,
  • Gordan Grahovac,
  • Babak Arvin,
  • Ahmed-Ramadan Sadek

摘要

Purpose

This study aimed to evaluate the prolapse to canal ratio (PCR) and its long-term impact on outcomes in cauda equina syndrome (CES).

Methods

A 5-year retrospective cohort study was conducted across two neurosurgical centers, including adult patients diagnosed with CES due to herniated lumbar discs, treated with laminectomy and/or discectomy, with available radiological data and follow-up. PCR was calculated as the proportion of the disc prolapse cross-sectional area to the total spinal canal area. MRI scans were independently analyzed by two investigators, with random verification by a third. Patient demographics, symptoms, treatment, and follow-up data were also collected.

Results

Among 137 patients, cohorts were divided using a PCR cut-off of 0.5. Patients with PCR > 0.5 were significantly more likely to have persistent symptoms at follow-up (OR 3.93, CI 2.25–7.34, p < 0.0001). This risk increased with higher PCR thresholds (> 0.75 and > 0.8). PCR > 0.5 also predicted a greater likelihood of requiring a full laminectomy over minimally invasive approaches (OR 2.14, 95% CI 1.3–3.6, p < 0.005). Lower PCR (< 0.5) was associated with reduced complication rates and shorter hospital stays.

Conclusions

PCR is a valuable predictor of persistent pain and functional deficits following CES surgery and could be used to guide patient counseling before surgical intervention.