Review/Perspective: Operations for Cauda Equina Syndromes - “The Sooner the Better”

Abstract

Background: Although most studies recommended that early surgery for cauda equina syndromes (CES) be performed within <48 h., the largest and most comprehensive Nationwide Inpatient Sample Database (NISC) series, involving over 25,000 CES patients recommended that time be shortened to 0–<24 h. In short, CES surgery performed “the sooner the better,” was best. Methods: The 2 major variants of CES include; incomplete/partial ICES, and those with urinary retention/bowel incontinence (RCES). Those with ICES often exhibit varying combinations of motor weakness, sensory loss (i.e. including perineal numbness), and urinary dysfunction, while RCES patients typically exhibit more severe paraparesis, sensory loss including saddle anesthesia, and urinary/bowel incontinence. The pathology responsible for ICES/RCES syndromes may include; acute disc herniations/stenosis, trauma (i.e. including iatrogenic/ surgical hematomas etc.), infections, abscesses, and other pathology. Surgery for either ICES/RCES may include decompressions to multilevel laminectomies/fusions. Results: Following early surgery, most studies showed that ICES and RCES patients exhibited improvement in motor weakness and sensory loss. However, recovery of sphincter function was more variable, being poorer for RCES patients with preoperative urinary retention/bowel incontinence. Conclusions: Although early CES surgery was defined in most studies as <48 h., two large NISC series involving over 25, 000 CES patients showed that CES surgery performed within 0 -< 24 h resulted in the best outcomes.

The negative impact of treatment delays on the long-term neurological outcomes of spinal dural arteriovenous fistulas: a longitudinal cohort study

“…10 This resonates with the notion that "time is spinal cord," which has been recognized in several domains relating to both acute and chronic injury to the spinal cord. For instance, in the context of acute injuries, delays in the treatment of traumatic spinal cord injury 22 or cauda equina syndrome 23 have been consistently associated with worse outcomes. Furthermore, in the context of chronic spinal cord injury and myelopathy, there is evidence suggesting that timely surgical management of extramedullary spinal cord tumors 24,25 or degenerative spine diseases 26,27 can be associated with improved postoperative neurological outcomes.…”