Timing of Surgery in Cauda Equina Syndrome

The authors reviewed available literature to evaluate the timing and outcomes of surgery for Cauda Equina Syndrome, CES. Two stages of CES have been reported. These are incomplete cauda equina syndrome (CESI) and cauda equina syndrome with retention (CESR). Compromise of urinary function that can be permanent is usually what prompts surgical intervention. Most surgeons feel that surgical treatment for CES should be on an emergent basis, the sooner the better in order to avoid permanent damage. However, studies have not demonstrated this to be the case.

In addition to impaired urinary function, rectal and sexual function may also be affected. Most persons with cauda equina syndrome will also have sensory deficits in the saddle area. Pain in the low back and or legs can also occur.

The cause of CESR in the literature that was considered for review was herniated lumbar disc, with or without spinal stenosis. In the United States, it is hypothesized that 0.12 percent of herniated discs result in CES.

The authors reviewed available literature involving the timing of surgery for CESR. Patients' perceived urinary function following surgery was the outcome that was evaluated. Function was categorized as normal, fair, and poor. While the analysis of the available literature was difficult, the authors state that the findings of their study support early surgical intervention for CES in order to achieve the most desirable outcomes.