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A patient with cauda equina syndrome must undergo decompression surgery as a matter of urgency. The surgical technique favoured by most surgeons treating CES is a micro discectomy.
Cauda equina syndrome is when the nerves at the base of the spine are compressed and injured, impairing neurological function in the legs, bladder and saddle region. The condition is a medical emergency, meaning treatment must be given immediately if serious complications are to be prevented.
The type of treatment required is lumbar decompression surgery. There are different types of lumbar decompression surgery, and the type of procedure carried out will depend upon the patient and the surgeon’s skill set. For patients who develop cauda equina syndrome because of a central disc prolapse, the procedure of choice is normally a micro discectomy.
During a micro discectomy, the surgeon will remove the section of the damaged disc that is pressing upon the cauda equina nerves. This is achieved by shaving away part of the disc, leaving the majority of the disc in place.
This procedure will not be carried out on all patients with cauda equina syndrome. Some may have a fusion procedure, whereby the damaged disc is removed and the surrounding vertebrae joined together with a bone graft. Alternatively some patients may have a laminectomy, whereby an arch of bone called the lamina is removed from the disc.
Whatever method is selected, it is absolutely essential that lumbar decompression surgery is performed as quickly as possible. This is because it takes a very short space of time for the cauda equina nerves to be irreparably damaged.
There is much debate as to how long it takes for the nerves to become irreparably harmed, with most experts agreeing that decompression surgery must be performed within 48 hours of the onset of symptoms. If surgery is delayed for over 48 hours, it is very likely that a patient will be left with a degree of permanent disability. In some patients this disability will be severe, incorporating paralysis of the legs, bladder dysfunction and bowel dysfunction.
If cauda equina syndrome is not treated in time, it must be considered whether medical error is to blame. If substandard medical care was at play – perhaps because doctors failed to make a timely diagnosis or appreciate the urgency with which surgery is needed – there will be grounds for a medical negligence compensation claim.
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