Treatment of cauda equina syndrome

Cauda equina syndrome is a neurological emergency.

Any delay in root decompression will reduce the chance of full motor and sphincter recovery and decompression surgery should be performed as soon as possible. The level of neurological dysfunction at the time of surgery (rather than time since symptom onset) is the most likely significant determinant of prognosis (1)

The goal of surgery is to decompress the cauda equina, which may be achieved through a number of surgical techniques, such as a wide-decompressive laminectomy or lumbar microdiscectomy. Full laminectomy is necessary for adequate exposure. (2)

Sphincter recovery is often incomplete, and sexual difficulties may persist. Outcomes after surgery tend to be worse for patients with urinary retention than for those with incomplete CES. (3) Patients with bilateral sciatica or complete perianal anaesthesia also have a less favourable prognosis than patients with unilateral pain. (4)

Reference

1. Epstein NE. Review/perspective: operations for cauda equina syndromes - "The sooner the better". 2022 Mar 25;13:100.
2. Spector LR et al. Cauda equina syndrome. J Am Acad Orthop Surg. 2008 Aug;16(8):471-9.
3. Hazelwood JE et al. An assessment of patient-reported long-term outcomes following surgery for cauda equina syndrome. Acta Neurochir (Wien). 2019 Sep;161(9):1887-94.
4. Tamburrelli FC et al; Cauda equina syndrome: evaluation of the clinical outcome. Eur Rev Med Pharmacol Sci. 2014;18(7):1098-105.