“Cauda equina” is Latin for “horse’s tail,” and cauda equina syndrome (CES) is a disorder of the nerve bundle at the bottom of the spinal cord, which fans out like a horse’s tail. When those nerves are compressed, a number of distressing symptoms may arise, from low back pain and sciatica to numbness in the buttocks and inner thighs (“saddle anesthesia”) to urinary, bowel, and sexual dysfunction.
These symptoms, especially when they come on quickly, are alarming. Most people wisely seek treatment on an emergency basis. We say “wisely” because early treatment is critical for cauda equina syndrome, and mere hours can make a difference in the outcome. Surgical Neurology International journal published a report that recommends early surgery for CES be performed within 24 hours, not 48 hours as had previously been thought. When the onset of symptoms is sudden, it’s ideal for surgical intervention to take place even sooner, preferably within eight hours after symptoms appear. In some cases, failure to expedite surgical intervention may constitute medical malpractice.
The truth is that when it comes to surgery for cauda equina syndrome, “the sooner the better” should be the rule. What kind of surgery is available for CES, and how does it help patients?
As soon as cauda equina syndrome is diagnosed, medical caregivers should begin preparing to get the patient into surgery as quickly as possible. Surgery is essential to relieve pressure on the nerves and allow for decompression of the nerve root to prevent permanent damage.
However, there are various conditions which can cause CES, and depending on the cause, different surgical interventions may be required. So while a diagnosis of CES may be suspected from symptoms, it will be necessary to identify the cause of the nerve root compression before attempting treatment.
The first step is to take a medical history and perform a physical examination to understand the progression of symptoms and assess sensation, muscle strength, and neurological function. Following that, imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT) scanning should be performed.
MRIs are often used to visualize the spine and surrounding structures, identifying conditions such as a herniated disc or a tumor which could be compressing nerves. CT scans are especially helpful for evaluating bony structures of the spine, such as spinal stenosis (narrowing) or fracture. Other diagnostic tests, such as electromyography (EMG) and nerve conduction studies may also be performed to assess nerve functioning and potential damage. In some cases, blood tests may be used to rule out inflammatory conditions or infection that may be contributing to nerve compression.
Once the cause of nerve compression is understood, the medical team can move forward with surgical intervention. Some possible treatments for cauda equina syndrome include:
A laminectomy removes a portion of the bony arch of the vertebra called the lamina; doing so can relieve nerve compression from stenosis (narrowing of the spine).
Somewhat less invasive than a laminectomy, a laminotomy involves removing a smaller portion of the lamina.
As the name suggests, a discectomy is the removal of part of a bulging or herniated disc; microdiscectomy, also called microdecompression, is considered the “gold standard” approach for removing a portion of a bulging disc.
The neural foramen is the opening through which nerves exit the spinal canal. A foraminotomy is performed in conditions such as foraminal stenosis to relieve pressure on the nerve roots.
Less commonly, cauda equina syndrome is caused by a tumor that is causing the compression of the nerve root. Depending on the nature and location of the tumor, all or part of it may be removed.
Patients often experience significant pain relief after surgery. However, it may take weeks, months, or even longer for certain physical functions to return. In some cases, especially where diagnosis and treatment are delayed, loss of function may be permanent.
With some medical conditions, it is reasonable to take a “wait and see” approach to allow the situation to improve or resolve without invasive measures. Unfortunately, cauda equina syndrome is not one of those conditions. Like the “golden hour” in stroke treatment, every minute in treating cauda equina syndrome is precious. It’s true that many of the symptoms of cauda equina syndrome are also present in other conditions. That said, because of the potential for serious and permanent damage from CES, doctors should take steps to rule it out before assuming symptoms are caused by something else. Failure to promptly evaluate a patient for cauda equina syndrome may constitute medical malpractice. Damages in these cases can be significant.
To learn more about surgery for cauda equina syndrome, or what to do if your doctor failed to properly address your symptoms, contact The Fraser Law Firm P.C. to schedule a consultation.
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