Cauda Equina Syndrome: Timing of Surgery and Outcome

The outcome for cauda equina syndrome will be much improved if surgery is performed in the early stages, before the condition becomes complete.

Incomplete/Complete CES

In an article, Gleave and Macfarlane draw attention to the importance in distinguishing two sub-groups of cauda equina syndrome.

The first group is a patient with urinary difficulties of a neurogenic origin, including altered urinary sensation, loss of desire to void, poor urinary stream and a need to strain in order to urinate. They define this group as an incomplete cauda equina syndrome (CES-I).

The second group is referred to as complete cauda equina syndrome (CES-R) with painless urinary retention and overflow incontinence. The most important feature of CES-R is the total loss of bladder control.

Timing of surgery

Medical experts do not agree upon the timing of surgery for cauda equina syndrome. For example:

• Ahn et al suggest patients must be treated within 48 hours of the onset of symptoms.
• Kohles suggests that surgery must be performed within 24 hours of the onset of symptoms.
• Jennett and Hussain believe that emergency surgery is not justified and will not make a difference to the neurological outcome.

There is, therefore, considerable uncertainty in the literature regarding surgical outcomes in relation to the timing of the operation.

It is, however, reasonable to state that surgery is best performed when the neurological deficit is least. This means that the outcome will be improved if a patient is treated while still in the incomplete stage.

Treating incomplete CES

When cauda equina syndrome first occurs, a patient will have incomplete CES. If treatment is not provided, it will progress to complete CES. The condition can progress to the complete stages within days (gradual onset), or over a matter of months (gradual onset).

Because of the speed at which the condition can become complete, medical professionals must act quickly. Patients with incomplete CES must be considered true emergencies and require emergency scanning and surgical intervention, even if that may mean an operation during the night.

Failing to provide emergency treatment

If there is a failure to treat a patient in the incomplete stage, the standard of care will have fallen below an acceptable level. If a patient consequently progresses to the complete stage, resulting in a poor medical outcome, there may be grounds for a medical negligence compensation claim.

If doctors failed to treat your cauda equina syndrome in time, causing you to suffer complications, please get in touch with us today.

Please call us free on 0800 234 3300, from a mobile click to call 01275 334030 or complete our Free Online Enquiry for a no cost, no obligation opinion.

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