---
title: "Cauda Equina Syndrome in Elderly Patients with Diabetes Mellitus: Diagnostic Delays, Surgical Outc"
id: "pubmed-42664151"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42664151"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42664151/"
doi: "10.7417/CT.2026.2131"
published_at: "2026-09-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Cauda Equina Syndrome in Elderly Patients with Diabetes Mellitus: Diagnostic Delays, Surgical Outc
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42664151
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42664151/)
- **DOI:** [10.7417/CT.2026.2131](https://doi.org/10.7417%2FCT.2026.2131)
- **Published At:** 2026-09-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Systematic review and meta-analysis examined **cauda equina syndrome (CES)** in elderly patients with **diabetes mellitus** across 28 studies (2016–2025) including 1,427 patients. - The pooled mean diagnostic delay was 4.8 days (95% CI: 3.9–5.7), indicating frequent delays to identification and treatment. - Classical symptom saddle anesthesia was absent in 38.7% of patients at presentation, contributing to diagnostic difficulty. - Early **surgical decompression** (within 48 hours) was associated with significantly improved **bladder recovery** (OR 2.74; 95% CI: 1.89–3.97; I²=38%). - Higher preoperative **HbA1c** was linked to worse neurological recovery: each 1% increase correlated with a 4.3% reduction in recovery (p=0.003). - Perioperative complications were common, with a pooled complication rate of 34.7% (95% CI: 29.1–40.3%). Thirty-day mortality in the pooled sample was 2.2%. - Authors conclude elderly diabetic CES patients experience delayed diagnosis and higher perioperative risk; they recommend timely decompression and optimized glycaemic control and call for tailored diagnostic pathways for this population.
## Clinical Analysis & Structured Key Points
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more resources ](https://pubmed.ncbi.nlm.nih.gov/42664151/#linkout) Title & authors Abstract Similar articles Publication types MeSH terms LinkOut - more resources Meta-Analysis Clin Ter Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Clin+Ter%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Clin+Ter%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42664151/) . 2026 Sep-Oct;177(5):1299-1316. doi: 10.7417/CT.2026.2131. # 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](https://pubmed.ncbi.nlm.nih.gov/?term=Alhalki+M&cauthor_id=42664151)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-1 "Emergency Department, West Middlesex University Hospital, Isleworth, United Kingdom."), [Neveen Shalaby](https://pubmed.ncbi.nlm.nih.gov/?term=Shalaby+N&cauthor_id=42664151)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-2 "Internal Medicine Department, Faculty of Medicine, Tanta University, Egypt."), [Zenat Khired](https://pubmed.ncbi.nlm.nih.gov/?term=Khired+Z&cauthor_id=42664151)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-3 "Orthopaedic Division, Department of Surgery, College of Medicine, Jazan University, Jazan, Saudi Arabia."), [Ahmed Adel Ayad](https://pubmed.ncbi.nlm.nih.gov/?term=Ayad+AA&cauthor_id=42664151)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-4 "Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt."), [Mona Atef Alatar](https://pubmed.ncbi.nlm.nih.gov/?term=Alatar+MA&cauthor_id=42664151)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-5 "Department Of Neurology, Faculty of Medicine, Benha University, Egypt."), [Hatem Attia Mostafa Ismail](https://pubmed.ncbi.nlm.nih.gov/?term=Ismail+HAM&cauthor_id=42664151)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-6 "Department of Clinical Pathology, National Liver Institute, Menoufia University, Shebin Elkom, Egypt."), [Neeveen Abdel Latif Fahmy Elshewy](https://pubmed.ncbi.nlm.nih.gov/?term=Elshewy+NALF&cauthor_id=42664151)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-7 "Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt."), [Walaa Yusif](https://pubmed.ncbi.nlm.nih.gov/?term=Yusif+W&cauthor_id=42664151)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-8 "Department of Geriatric Medicine and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt."), [Tamer Hassan Rashwan](https://pubmed.ncbi.nlm.nih.gov/?term=Rashwan+TH&cauthor_id=42664151)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-9 "Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Assiut, Egypt."), [Ahmed Atef Ganna](https://pubmed.ncbi.nlm.nih.gov/?term=Ganna+AA&cauthor_id=42664151)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-10 "Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt."), [Mariam Ghanem](https://pubmed.ncbi.nlm.nih.gov/?term=Ghanem+M&cauthor_id=42664151)[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-11 "Department of Neurosurgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt."), [Mohamed Hashem Youssef Abdou](https://pubmed.ncbi.nlm.nih.gov/?term=Abdou+MHY&cauthor_id=42664151)[ 12 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-12 "Orthopedic and Spine Surgery Department, Makkah Medical Center Hospital, Makkah, Saudi Arabia."), [Rasha Zaki](https://pubmed.ncbi.nlm.nih.gov/?term=Zaki+R&cauthor_id=42664151)[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-11 "Department of Neurosurgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt."), [Mahmoud Kamel Elawady](https://pubmed.ncbi.nlm.nih.gov/?term=Elawady+MK&cauthor_id=42664151)[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-11 "Department of Neurosurgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt."), [Amr A Abdelkader](https://pubmed.ncbi.nlm.nih.gov/?term=Abdelkader+AA&cauthor_id=42664151)[ 13 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#full-view-affiliation-13 "Department of Diagnostic and Interventional Radiology and Molecular Imaging, Faculty of Medicine, Ain Shams University, Cairo, Egypt.") Affiliations Expand ### Affiliations * 1 Emergency Department, West Middlesex University Hospital, Isleworth, United Kingdom. * 2 Internal Medicine Department, Faculty of Medicine, Tanta University, Egypt. * 3 Orthopaedic Division, Department of Surgery, College of Medicine, Jazan University, Jazan, Saudi Arabia. * 4 Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. * 5 Department Of Neurology, Faculty of Medicine, Benha University, Egypt. * 6 Department of Clinical Pathology, National Liver Institute, Menoufia University, Shebin Elkom, Egypt. * 7 Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt. * 8 Department of Geriatric Medicine and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt. * 9 Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Assiut, Egypt. * 10 Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt. * 11 Department of Neurosurgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt. * 12 Orthopedic and Spine Surgery Department, Makkah Medical Center Hospital, Makkah, Saudi Arabia. * 13 Department of Diagnostic and Interventional Radiology and Molecular Imaging, Faculty of Medicine, Ain Shams University, Cairo, Egypt. * PMID: **42664151** * DOI: [ 10.7417/CT.2026.2131 ](https://doi.org/10.7417/ct.2026.2131) Free article Item in Clipboard Meta-Analysis # 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 et al. Clin Ter. 2026 Sep-Oct. Free article Show details Display options Display options Format Abstract PubMed PMID Clin Ter Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Clin+Ter%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Clin+Ter%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42664151/) . 2026 Sep-Oct;177(5):1299-1316. doi: 10.7417/CT.2026.2131. ### Authors [Mohd Alhalki](https://pubmed.ncbi.nlm.nih.gov/?term=Alhalki+M&cauthor_id=42664151)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-1 "Emergency Department, West Middlesex University Hospital, Isleworth, United Kingdom."), [Neveen Shalaby](https://pubmed.ncbi.nlm.nih.gov/?term=Shalaby+N&cauthor_id=42664151)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-2 "Internal Medicine Department, Faculty of Medicine, Tanta University, Egypt."), [Zenat Khired](https://pubmed.ncbi.nlm.nih.gov/?term=Khired+Z&cauthor_id=42664151)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-3 "Orthopaedic Division, Department of Surgery, College of Medicine, Jazan University, Jazan, Saudi Arabia."), [Ahmed Adel Ayad](https://pubmed.ncbi.nlm.nih.gov/?term=Ayad+AA&cauthor_id=42664151)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-4 "Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt."), [Mona Atef Alatar](https://pubmed.ncbi.nlm.nih.gov/?term=Alatar+MA&cauthor_id=42664151)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-5 "Department Of Neurology, Faculty of Medicine, Benha University, Egypt."), [Hatem Attia Mostafa Ismail](https://pubmed.ncbi.nlm.nih.gov/?term=Ismail+HAM&cauthor_id=42664151)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-6 "Department of Clinical Pathology, National Liver Institute, Menoufia University, Shebin Elkom, Egypt."), [Neeveen Abdel Latif Fahmy Elshewy](https://pubmed.ncbi.nlm.nih.gov/?term=Elshewy+NALF&cauthor_id=42664151)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-7 "Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt."), [Walaa Yusif](https://pubmed.ncbi.nlm.nih.gov/?term=Yusif+W&cauthor_id=42664151)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-8 "Department of Geriatric Medicine and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt."), [Tamer Hassan Rashwan](https://pubmed.ncbi.nlm.nih.gov/?term=Rashwan+TH&cauthor_id=42664151)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-9 "Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Assiut, Egypt."), [Ahmed Atef Ganna](https://pubmed.ncbi.nlm.nih.gov/?term=Ganna+AA&cauthor_id=42664151)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-10 "Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt."), [Mariam Ghanem](https://pubmed.ncbi.nlm.nih.gov/?term=Ghanem+M&cauthor_id=42664151)[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-11 "Department of Neurosurgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt."), [Mohamed Hashem Youssef Abdou](https://pubmed.ncbi.nlm.nih.gov/?term=Abdou+MHY&cauthor_id=42664151)[ 12 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-12 "Orthopedic and Spine Surgery Department, Makkah Medical Center Hospital, Makkah, Saudi Arabia."), [Rasha Zaki](https://pubmed.ncbi.nlm.nih.gov/?term=Zaki+R&cauthor_id=42664151)[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-11 "Department of Neurosurgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt."), [Mahmoud Kamel Elawady](https://pubmed.ncbi.nlm.nih.gov/?term=Elawady+MK&cauthor_id=42664151)[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-11 "Department of Neurosurgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt."), [Amr A Abdelkader](https://pubmed.ncbi.nlm.nih.gov/?term=Abdelkader+AA&cauthor_id=42664151)[ 13 ](https://pubmed.ncbi.nlm.nih.gov/42664151/#short-view-affiliation-13 "Department of Diagnostic and Interventional Radiology and Molecular Imaging, Faculty of Medicine, Ain Shams University, Cairo, Egypt.") ### Affiliations * 1 Emergency Department, West Middlesex University Hospital, Isleworth, United Kingdom. * 2 Internal Medicine Department, Faculty of Medicine, Tanta University, Egypt. * 3 Orthopaedic Division, Department of Surgery, College of Medicine, Jazan University, Jazan, Saudi Arabia. * 4 Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt. * 5 Department Of Neurology, Faculty of Medicine, Benha University, Egypt. * 6 Department of Clinical Pathology, National Liver Institute, Menoufia University, Shebin Elkom, Egypt. * 7 Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Ain Shams University, Cairo, Egypt. * 8 Department of Geriatric Medicine and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt. * 9 Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Assiut, Egypt. * 10 Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt. * 11 Department of Neurosurgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt. * 12 Orthopedic and Spine Surgery Department, Makkah Medical Center Hospital, Makkah, Saudi Arabia. * 13 Department of Diagnostic and Interventional Radiology and Molecular Imaging, Faculty of Medicine, Ain Shams University, Cairo, Egypt. * PMID: **42664151** * DOI: [ 10.7417/CT.2026.2131 ](https://doi.org/10.7417/ct.2026.2131) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Cauda equina syndrome (CES) is a rare but severe neurological emergency requiring urgent surgical decompression. In elderly patients with diabetes mellitus, overlapping neuropathic features may obscure classical CES presentation, leading to delayed diagnosis and worse outcomes. **Objectives:** To evaluate diagnostic challenges, surgical management, perioperative complications, and recovery outcomes in elderly diabetic patients with CES. **Methods:** A systematic search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL was conducted for studies published between January 2015 and April 2026. Two independent reviewers performed study selection, data extraction, and risk of bias assessment. Random-effects meta-analyses were conducted, and heterogeneity was assessed using the I² statistic. **Results:** Twenty-eight studies, published between 2016 and 2025 across 14 countries, comprised 1,427 elderly patients with diabetes mellitus and confirmed CES were analyzed. The pooled mean diagnostic delay was 4.8 days (95% CI: 3.9-5.7). Saddle anaesthesia was absent at presentation in 38.7% of patients. Surgical decompression within 48 hours significantly 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%. **Conclusions:** Elderly diabetic patients with CES experience delayed diagnosis and increased perioperative risk. Early surgical decompression within 48 hours and optimal glycaemic control are key determinants of improved outcomes. Tailored diagnostic pathways for this population are warranted. **Keywords:** Cauda Equ
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