Treatment of Cauda Equina Syndrome (CES)
If there is compression of the nerve structures in the lumbar spine an emergency decompression of the affected nerves is performed without delay.
The decompression or discectomy operation is performed by a spinal surgeon or neurosurgeon to remove the protruding fragment of the disc (or tumour/fracture) which is compressing the nerves.
Patients are operated on as soon as possible, and in Kostuik’s study they were operated on an average of 1.1 days after onset of symptoms of CES.
What is the outcome of CES?
Much of the information about recovery comes from the work of Kostuik et al. In one study he reviewed the recovery from the point of bladder function, sexual function and motor/sensory recovery.
23 out of 30 people operated on had normal voiding of urine within 3 to 14 days of operation.
The seven remaining made a partial recovery of bladder function. Some patients felt they had satisfactory bladder function even though measurements made of bladder function showed that it had not returned to normal.
In a study by Gleave and MacFarlane some patients took two years after surgery to recover bladder function.
8 people still had some sexual dysfunction at the last follow-up 24 months after operation.
Motor and Sensory Recovery
27 out of the 30 had full recovery of muscle function, with 3 people having continuing weakness or abnormalities of feeling. Recovery times varied from two days to six months, and most recovered in six months.
All patients who had residual problems after surgery had marked sequestration of the disc material at surgery - the disc material had protruded far enough to lose contact with the main body of the disc and exist as an independent fragment.
Gleave and MacFarlane state that the die is cast when the disc prolapses initially. There seems to be no evidence to support the idea that emergency surgery influences the outcome. However, if surgery is not performed in the presence of urinary retention there is a risk of kidney failure and death. And there is the small matter of pain relief!