Abstract
Introduction
Cauda Equina is a condition requiring urgent operative intervention to avoid debilitating long term neurological compromise. The recommended maximium time delay before lack of surgical decompression results in persisting neurological deficit has been suggested to be 24 hrs and more recent studies have even indicated 48 hours as acceptable. We wanted to assess if any persisting neurological deficit occurred in our practice when treated at 12 hours or less.
Aim
To assess if patients treated within half of the maximum recommended time for surgical decompression following cauda equina i.e 12 hours, are still pre-disposed to persisting neurological compromise.
Methods
We reviewed all patients who underwent a spinal decompression for cauda equina, based on clinical presentation, examination and magnetic resonance imaging at our institution. Over a seven year period, seven patients were found to have operative findings consistent with cauda equina syndrome. The clinical presentation, time from presentation to operative decompression and type of procedure done, as well as the clinical review at follow up, were noted.
Results
The time from presentation to operation was 8 hours 30 mins to 11 hours 48 in 6 patients and 25 hrs in one patient.
All seven patients had resolution of symptoms except for dermatomal sensory deficit. Two patients had some recurrence of sciatica, two of these patients having similar operations done at the same level within 18 months.
Discussion
Our study shows that urinary compromise resolves with early decompression but that persisting neurological symptoms in the form of sensory deficit can persist even when decompression is performed within 12 hours. We conclude that early decompression is necessary but it does not alleviate all neurological symptoms.
