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