Cauda Equina Syndrome (CES)
Why is there such urgency to take patient to surgery?
Cauda equina syndrome is thought to occur in three different pattern types. It can present as the first symptom after the acute herniation of a lumbar intervertebral disk (Type 1), as the final symptom in the patient with a long history of low back pain without symptoms extending down the leg (Type 2), or insidiously progressing to numbness and urinary symptoms (Type 3).
Historically, cauda equina syndrome is treated as an emergency, and once the diagnosis is made, the patient is taken to the operating room for surgical decompression.
Decompressive surgery should be carried out as an emergency.
O'Laoire S A, Crockard H A, Thomas D G. Prognosis for sphincter recover after operation for operation for cauda equina compression owing to lumbar disc prolapse. BMJ 1981; 282: 1852–1854
Following a complete lesion the timing of surgery does not influence outcome.
Gleave J RW, MacFarlane R. Prognosis for recovery of bladder function following lumbar central disc prolapse. Br J Neurosurg 1990; 4: 205–210
Decompression achieved ‘early’ achieves statistically better outcomes than ‘late’ decompression.
Dinning T AR, Schaeffer H R. Discogenic compression of the cauda equina: a surgical emergency. Aust NZ J Surg 1993; 63: 927–934