Surgery

In many cases of cauda equina syndrome, emergency decompression of the spinal canal is the best treatment option. The goal is to relieve pressure on the nerves of the cauda equina by removing the compressing structures and increasing the space available for the nerves in the spinal canal. Traditionally, cauda equina syndrome has been considered a surgical emergency, with surgical decompression considered necessary within 48 hours of the onset of symptoms.

For people with a herniated disk as the cause of cauda equina syndrome, removal of a portion of the bone surrounding the nerves (laminectomy) is performed and the disk material compressing the nerves is removed (discectomy). Many clinical and experimental reports have presented data on the functional outcome based on the timing of surgical decompression. Some investigators have reported no significant differences in the degree of functional recovery as a function of the timing of surgical decompression. Even with these findings, however, most investigators recommend surgical decompression as soon as possible following onset of symptoms to offer the greatest chances of complete neurologic recovery.

Many clinical and experimental studies have investigated patient outcomes in relation to the timing of surgical decompression. Some investigators have reported no significant differences in the degree of functional recovery as a function of the timing of surgical decompression. Even with these findings, however, most investigators recommend surgical decompression as soon as possible following the onset of symptoms to offer the greatest chances of complete neurologic recovery.

Investigators have attempted to identify specific criteria that can aid in predicting the outcome of persons with cauda equina syndrome.

• People with pain in both legs (bilateral sciatica) have less chance or full recovery than persons with single leg pain (unilateral sciatica).
  
  
• People with complete groin numbness (perineal anesthesia) are more likely to have permanent paralysis of the bladder.
  
  
• The extent of groin numbness (perineal or saddle sensory deficit) is the most important predictor of recovery.