Outcome of Early Surgery vs Delayed Surgery in Cauda Equina Syndrome

Cauda equina syndrome is best treated as early as possible. This will improve the eventual outcome.

Incomplete and complete cauda equina syndrome

The signs of an incomplete cauda equina syndrome include reduced bladder sensation, numbness around the buttocks/perineum/anus, and difficulty urinating. However, the patient will not have gone into urinary retention with overflow incontinence.

When a patient goes into urinary retention with overflow incontinence, their condition has progressed to complete cauda equina syndrome. Some patients will never go into urinary retention and therefore never reach a stage of cauda equina syndrome complete with urinary retention and overflow.

Outcome of incomplete and complete cauda equina syndrome

Those patients with incomplete cauda equina syndrome have an improved outcome the earlier the surgery, right up until the time they develop complete cauda equina syndrome. In other words, those operated on within 12 hours verses 24 hours verses 48 hours verses 96 hours, have an improved chance of a normal bladder recovery.

Unfortunately once the patient has complete cauda equina syndrome there is little hope of a full recovery. The nerves have been badly damaged and even surgery cannot restore their function.

Study of early surgery and improved bladder outcome

The difference between early and delayed surgery has been verified in a medical study. Two hundred patients were assessed between 2000 and 2011, all of whom had previously undergone surgical decompression for cauda equina syndrome.

Of these, 139 patients had incomplete cauda equina syndrome. The outcome differed according to the timing of surgery:

• Of the 36 patients who had surgery under 24 hours of the onset of symptoms, just four were left with bladder dysfunction.
• Of the 103 had patients who had surgery more than 24 hours after the onset of symptoms, 48 were left with bladder dysfunction.

The remaining 61 patients had complete cauda equina syndrome. The study concluded that there was little difference in outcome for those operated on within 24, 48 or 72 hours after the onset of symptoms.

Therefore the outcome is greatly improved if surgery is carried out within 24 hours of the onset of symptoms. Some improvement is possible if surgery is carried out within 48 hours of the onset of symptoms. But a poor outcome can be expected if surgery is not carried out until complete cauda equina syndrome has developed.

Delay in surgical treatment

If surgical decompression is delayed due to medical errors, causing a patient to suffer a poor outcome, there may be a case of medical negligence. Please contact us to find out more.

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.

Share Article With: