Does Timing of Surgery for Cauda Equina Lesion Matter?Lumbar disc herniation can cause serious symptoms of leg weakness, numbness in the groin, and loss of bowel or bladder control. This group of symptoms is called cauda equina syndrome (CES).
CES is rare but when it happens, surgery is required to prevent permanent or irreversible neurologic damage. Decompressive surgery is done to take pressure off the spinal nerves. Part or all of the herniated disc is removed.
Most physicians consider CES a surgical emergency. Surgery is required to prevent serious mental and physical disability. This study investigates the results of surgery based on when (how early) the surgery was done for 42 patients.
Five of the patients were operated on within 24 hours. At least half had surgery between 24 and 48 hours. The rest were delayed 48 hours or more. Age did not seem to affect the outcomes. Men and women had the same symptoms before the operation, but women had more problems with bladder control after the surgery.
Patients were followed for up to two years. In general,it did not appear that the timing of the surgical repair made a difference in the results. Even with treatment, the patients with CES did not return to normal. One-third were unable to return to work.
The authors could not say with absolute certainty that a delay in operation is good or bad. Common sense suggests early surgery to take pressure off the spinal nerves would give a better result, but there is no hard evidence for this.
Michael J. H. McCarthy, MRCS, et al. Cauda Equina Syndrome. Factors Affecting Long-Term Functional and Sphincteric Outcome. In Spine. January 15, 2007. Vol. 32. No. 2. Pp. 207-216.
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