Neurosurgery for Cauda Equina Syndrome

Updated: Nov 01, 2017
  • Author: Nazer H Qureshi, MD; Chief Editor: Brian H Kopell, MD  more...
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Overview

Background

In the United States, approximately 1-3% of patients who undergo spinal surgery for cauda equina syndrome (CES) have either atraumatic or traumatic types of CES. [1] CES has no predilection for any race or either sex. Although CES can occur at any age, it is most often seen in adults in whom the spinal canal may already be compromised and stenosed.

The prognosis for CES improves if a definitive cause is identified and management is instituted early. Surgical treatment may be necessary for decompression or tumor removal, especially if the patient presents with acute onset of symptoms. Surgical decompression should be performed if the patient is medically stable and able to undergo the procedure. [2, 3, 4, 5]

In acute compression of the conus medullaris or cauda equina, surgical decompression as soon as possible becomes mandatory. In a more chronic presentation with less severe symptoms, decompression could be performed when medically feasible and should be delayed to optimize the patient's medical condition; with this precaution, decompression is less likely to lead to irreversible neurologic damage.

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Technical Considerations

Anatomy

Images depicting cauda equina syndrome can be seen below.

Sagittal MRI of a patient with cauda equina syndro Sagittal MRI of a patient with cauda equina syndrome secondary to a large lumbar disk herniation.
Illustration demonstrating the relevant anatomy of Illustration demonstrating the relevant anatomy of the cauda equina region.
Illustration demonstrating an example of cauda equ Illustration demonstrating an example of cauda equina syndrome secondary to a spinal neoplasm.

Go to Cauda Equina and Conus Medullaris Syndromes and Tumors of the Conus and Cauda Equina for complete information on these topics.

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