There is much debate amongst medical experts as to how quickly treatment for cauda equina syndrome must be provided. In this article we explore the debate in greater detail.
Cauda equina syndrome and medical reviews
While most medical experts agree as to the symptoms of cauda equina syndrome, there is some confusion as to the timing of treatment.
In 2000, a meta-analysis by Ahn et al reviewed 104 citations and 42 articles. In total there were 322 patients included in the analysis. It concluded that there was significant improvement of motor, sensory and pelvic autonomic deficits (bowel, bladder and erectile function in the male) in patients treated within 48 hours to those patients treated after 48 hours.
In 2004, Kohles and Polissar et al criticised Ahn et al. They stated “a flawed methodology and misinterpretation of results are reported understating the value of surgical intervention.” In this report, Kohles concluded that surgery within 24 hours of onset is beneficial.
Others, including Todd et al, have also suggested that surgery within 24 hours is beneficial.
However, a number of retrospective studies consider that emergency surgery is not justified and the difference between urgently operated patients and those operating on the next available list with regard to neurological outcome and quality of life assessments reveal no difference.
This is reiterated in a paper by Gleave and Macfarlane in 2002, in which the authors state that the “dye is case at the time of lumbar disc prolapse.”
Nevertheless, all these studies have the disadvantage of small groups of patients, often the data is retrospective and there are conflicting results even when the same data is analysed by a different statistician.
Conclusion
There is, therefore, considerable uncertainly 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 and under optimum conditions.
Patients who undergo surgery when the syndrome remains incomplete are true emergencies and require emergency scanning and emergency surgical intervention, even if that may mean an operation during the night. This will give the best opportunity to prevent the incomplete syndrome deteriorating into cauda equina syndrome with retention,
In a patient where the cauda equina syndrome is already complete and there is evidence of urinary retention, the basis for investigation and surgery becomes urgent rather than an emergency.
Failure to provide treatment
If medical professionals fail to provide treatment while the condition is still incomplete, there may be grounds for a claim. Contact us to find out more.