eMedicine Specialties > Neurosurgery > Neoplasm

Cauda Equina: Treatment

Author: Nazer H Qureshi, MD, Staff Physician, Department of Neurosurgery, University of Arkansas for Medical Sciences
Coauthor(s): T Glenn Pait, MD, FACS, Associate Professor, Department of Neurosurgery, Department of Orthopaedic Surgery, Jackson T Stephens Chair, Spine Surgery, University of Arkansas for Medical Sciences; Director, Jackson T Stephens Spine and Neurosciences Institute; Emad Soliman, MD, MSc, Consulting Staff, Department of Neurology, St John's Riverside Hospital
Contributor Information and Disclosures

Updated: Jul 24, 2007

Treatment

Medical Therapy

Therapy is directed at the underlying cause of cauda equina syndrome (CES). The effective role of medical treatment in CES depends on the etiology. In patients with infection, antibiotics may be an imporant therapeutic avenue. In patients with certain kinds of tumor growths within the spinal canal, steroids, antichemotherapeutic agents, and radiation therapy may be important therapeutic avenues.

Surgical Therapy

The role of surgery is to relieve pressure from the nerves in the cauda equina (CE) region and to remove the offending elements. After spinal surgery, internal stabilization with fixation devices may be needed in the same operative setting or at a later date.

The timing of surgical decompression is controversial, with immediate, early, and late surgical decompression showing varying results. This concept is further discussed in Outcome and Prognosis.

Preoperative Details

Routine preoperative care is recommended. The only purpose of preoperative care is to make sure that the patient gets to the operating room in the recommended time frame to maximize chances of a complete recovery.

Intraoperative Details

The intraoperative use of somatosensory and motor-evoked potentials (SSEPs) may be helpful in monitoring the patient.

Postoperative Details

Routine postoperative care is necessary for all patients. The recovery time depends on the duration and the extent of symptoms of CES and a multitude of other factors, including the etiology. Postoperative physical and occupational therapies are often beneficial to the patient’s progress. Some patients may require inpatient or outpatient rehabilitation; therefore, a physical medicine and rehabilitation consultation should be considered early in the course of management.

Follow-up

If therapy is delayed, potential problems include residual weakness, incontinence, impotence, and sensory abnormalities. These problems may persist even with prompt decompression. Follow-up depends on the needs of the patient and recovery potential.

Complications

Ever-present adverse events of any spinal surgery include paralysis, along with urinary bladder, bowel, and sexual dysfunction. The specific risks of surgical complications for widely varied procedures and equally varied etiologies are beyond the scope of this article.

More on Cauda Equina

Overview: Cauda Equina
Workup: Cauda Equina
Treatment: Cauda Equina
Follow-up: Cauda Equina
References
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Further Reading

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Keywords

CE, cauda equina syndrome, CES, low back pain, steroid, epidural, conus medullaris syndrome, spinal stenosis, nerve root, sciatica, lumbar laminectomy, multiple myeloma, metastatic spinal disease, arthritis, degenerative arthritic lumbar stenosis

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Contributor Information and Disclosures

Author

Nazer H Qureshi, MD, Staff Physician, Department of Neurosurgery, University of Arkansas for Medical Sciences
Nazer H Qureshi, MD is a member of the following medical societies: American Association of Neurological Surgeons, Congress of Neurological Surgeons, and World Society for Stereotactic and Functional Neurosurgery
Disclosure: Nothing to disclose.

Coauthor(s)

T Glenn Pait, MD, FACS, Associate Professor, Department of Neurosurgery, Department of Orthopaedic Surgery, Jackson T Stephens Chair, Spine Surgery, University of Arkansas for Medical Sciences; Director, Jackson T Stephens Spine and Neurosciences Institute
T Glenn Pait, MD, FACS is a member of the following medical societies: American Association of Neurological Surgeons, American Medical Association, Arkansas Medical Society, Congress of Neurological Surgeons, North American Skull Base Society, North American Spine Society, and West Virginia State Medical Association
Disclosure: Nothing to disclose.

Emad Soliman, MD, MSc, Consulting Staff, Department of Neurology, St John's Riverside Hospital
Emad Soliman, MD, MSc is a member of the following medical societies: American Academy of Neurology and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Duc Hoang Duong, MD, Director of Neuroscience Physician Assistant Program, Associate Professor, Departments of Neurological Surgery and Neuroscience, Epilepsy Center, Charles R Drew University
Duc Hoang Duong, MD is a member of the following medical societies: American Neurological Association and North American Skull Base Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ryszard M Pluta, MD, PhD, Associate Professor, Neurosurgical Department Medical Research Center, Polish Academy of Sciences at Warsaw, Poland; Senior Researcher, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH
Disclosure: Nothing to disclose.

CME Editor

Herbert H Engelhard III, MD, PhD, Director, UIC Neuro-Oncology Program, Chief, Division of Neuro-Oncology, Associate Professor, Department of Neurosurgery, University of Illinois at Chicago
Herbert H Engelhard III, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, American Society for Cell Biology, American Society of Clinical Oncology, Chicago Medical Society, Congress of Neurological Surgeons, Illinois State Medical Society, Society for Neuro-Oncology, and Society for Neuroscience
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

 
 
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