Diagnostic and Surgical Challenges of Cauda Equina Syndrome in Elderly Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis of Clinical, Radiological, and Surgical Outcomes.
Mohd Alhalki, Neveen Shalaby, Zenat Khired et al.
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In 30 seconds
This systematic review and meta-analysis assessed diagnostic presentation, surgery, complications, and recovery in elderly patients with diabetes and confirmed cauda equina syndrome (CES). Across 28 studies involving 1,427 patients, pooled diagnostic delay was 4.8 days (95% CI: 3.9-5.7), and saddle anaesthesia was absent at presentation in 38.7%. Decompression within 48 hours was associated with better bladder recovery (OR: 2.74; 95% CI: 1.89-3.97; I²=38%). The pooled complication rate was 34.7% (95% CI: 29.1-40.3%), with 30-day mortality of 2.2%.
Key findings
- Pooled diagnostic delay was 4.8 days (95% CI: 3.9-5.7); saddle anaesthesia was absent in 38.7% at presentation.
- Decompression within 48 hours was associated with improved bladder recovery (OR: 2.74; 95% CI: 1.89-3.97; I²=38%).
- Each 1% increase in preoperative HbA1c was associated with a 4.3% reduction in neurological recovery (p=0.003).
- The pooled complication rate was 34.7% (95% CI: 29.1-40.3%), and 30-day mortality was 2.2%.
Why it matters
Diabetic neuropathic symptoms may overlap with CES features, while saddle anaesthesia was often absent in this review. These findings underscore the potential for diagnostic delay in a time-critical neurological emergency. The reported complication rate and mortality also highlight the substantial perioperative burden in this population.
What to keep in mind
The meta-analysis combines studies from multiple countries and reports heterogeneity for the bladder-recovery estimate (I²=38%); the abstract does not describe the underlying study designs.