What Does Decompression Surgery For Cauda Equina Syndrome Involve?

Cauda equina syndrome is when the nerves in the lower back become compressed, usually due to a slipped disc or lesion. It must be treated with urgent decompression surgery, or a patient could be left permanently paralysed and incontinent of urine.

Decompression surgery

If a patient is diagnosed with cauda equina syndrome, decompression surgery must be performed. No time should be wasted in taking a patient to the operating theatre where a specialist orthopaedic surgeon or a neurosurgeon must carry out the procedure. It is a complicated operation, so an experienced surgeon is vital.

The patient will need to lie face down on a curved operating table, as this will better expose the lower spine, but will reduce the pressure on the chest, abdomen and pelvis. A general anaesthetic will then be administered. Once the anaesthetist confirms that the patient is stable, the surgeon will make a surgical incision to the lower back.

The compressed nerves will need to be fully revealed, which is why open surgery is usually the most suitable option, rather than keyhole surgery. The surgeon will then proceed to alleviate the pressure being placed upon the cauda equina nerves.

The way in which compression is relieved will depend upon the exact cause of the problem. The surgeon will need to assess the MRI scan in advance of the operation, and consider the situation during surgery, before making a decision. There are a number of possible techniques, including:-

1. A laminectomy – this will be required if an arch or bone, or a ligament, is pressing upon the nerves.

2. A discectomy – this will be required if a piece of a vertebral disc is pressing upon the nerves.

3. A spinal fusion – this will be required if two or more vertebrae are joined together with a bone graft.

A surgeon may use one, two or all three of these techniques during decompression surgery, depending upon the nature of the injury.

Timing of decompression surgery

Cauda equina syndrome is a medical emergency, meaning it must be treated without delay if a patient is going to escape without long-term complications. Therefore once a diagnosis has been made, there should only be a short wait until surgery. A patient should not be sent home or put on a waiting list.

If there is a failure to perform urgent decompression surgery for cauda equina syndrome and this causes a patient to suffer unnecessary injury, the level of care will be considered substandard and there will be grounds for a medical negligence compensation claim.

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