Timing of Surgical Decompression for Cauda Equina Syndrome

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

“…including ICES and RCES syndromes) included; varying severities of sciatica, motor weakness, sensory loss with reduced perineal sensation, bladder/bowel dysfunction/urinary retention, and loss of sexual function [ Table 1 ]. [ 1 , 4 - 6 , 9 , 10 , 13 , 14 , 16 - 18 ] ICES patients usually exhibited varying motor weakness, sensory deficits (i.e. perineal numbness), and urinary dysfunction, while RCES patients more typically had paresis/paralysis, more severe sensory loss including saddle anesthesia, and urinary/bowel retention/incontinence.…”

“…Most smaller studies recommended early surgery for CES (ICES/RCES) within <48 h. [ Table 1 ]. [ 1 , 4 , 6 , 10 , 16 - 18 ] However, two of the largest and highest quality NISC series documented that surgery performed from 0-<24 h after the onset of symptoms or performed “the sooner the better”, resulted in the best outcomes [ Table 1 ]. [ 1 , 4 , 6 , 10 , 16 , 18 ] In 2017, Thakur et al ., using the NISC (2005–2011) database involvling 4066 adults with CES, determined that surgery in ICES patients performed in <24 h. resulted in better outcomes with lower mortality rates, shorter lengths of stay, lesser hospital charges, and a reduced rate of unfavorable discharges versus surgery performed after 48 h [ Table 1 ].…”

“…performed within 0–<24 h.) resulted in lower complication and mortality rates. [ 10 ] The operations performed in most studies included decompressive laminectomies with occasional decompressions/fusions [ Table 1 ]. [ 3 , 7 , 10 , 12 , 13 , 15 , 17 , 18 ]…”

“…[ 1 , 3 - 18 ] Early surgery for CES was typically defined as within <48 h. after the onset of symptoms/signs; however, the two largest Nationwide Inpatient Sample Database (NISC) series recommend that CES surgery be completed within 0–<24 h. to achieve the best outcomes [ Table 1 ]. [ 1 , 4 - 6 , 9 , 10 , 14 , 16 - 18 ] CES syndromes are divided into incomplete/partial CES (ICES) versus complete/retention/incontinence CES (RCES) syndromes based upon the respective lesser or greater severity of preoperative motor, sensory, and/or sphincteric deficits. [ 9 , 16 , 17 ] ICES/RCES syndromes were largely attributed to; acute disc herniations/stenosis, iatrogenic-surgical trauma, trauma/fractures, infections/abscesses, and other factors.…”

“…[ 1 - 18 ] Early surgery, predominantly including laminectomy to multilevel decompressions with/ without fusions, increased the probability of better outcomes for both ICES and RCES populations. [ 1 , 4 - 6 , 9 , 10 , 14 , 16 - 18 ]…”