A 45-year-old woman presents with bilateral leg weakness, saddle anaesthesia, and acute urinary retention following a large central L4–L5 disc prolapse. Urgent MRI confirms massive sequestered disc herniation compressing the cauda equina. The single most important prognostic factor for recovery of bladder function is:

• A Patient's age and pre-existing disc degeneration
• B Degree of motor weakness in the lower extremities
• C Size of the disc fragment on MRI
• D Duration of bladder dysfunction before surgical decompression ✓

Explanation

In cauda equina syndrome (CES), the most critical prognostic factor for recovery of bladder and bowel function is the duration of urinary symptoms (retention or incontinence) before surgical decompression. Guidelines recommend emergency decompressive surgery, ideally within 24–48 hours of onset of sphincter disturbance. Recovery of micturition is significantly better with decompression within 24 hours compared to delays beyond 48–72 hours. Perianal sensation and voluntary sphincter contraction at the time of surgery are additional prognostic indicators.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.