Early Versus Delayed Decompression in Cauda Equina Syndrome: Neurological and Functional Outcomes

Area of Science:

• Neurosurgery
• Orthopedics
• Urology

Background:

• Cauda equina syndrome (CES) is a surgical emergency requiring prompt intervention.
• Timely decompression is critical for preserving neurological and functional outcomes.
• Optimal timing for surgical decompression in CES remains a subject of investigation.

Purpose of the Study:

• To compare neurological and functional outcomes between early (≤48 hours) and delayed (>48 hours) surgical decompression in adult CES patients.
• To evaluate the impact of surgical timing on bladder function, neurological recovery, and sensory disturbances.

Main Methods:

• A descriptive study involving adult patients diagnosed with CES.
• Patients were categorized into early decompression (ED) and delayed decompression (DD) groups based on symptom onset to surgery time.
• Neurological function assessed using the Modified Frankel Scale (MFS); bladder function, saddle paresthesia were primary/secondary outcomes.
• Statistical analysis performed using Fisher's exact test.

Main Results:

• Thirty-six patients were included; 41.7% underwent ED and 58.3% DD.
• At 1-year follow-up, persistent bladder dysfunction was significantly lower in the ED group (13.3%) vs. DD group (47.6%; p=0.040).
• 88.9% of all patients showed ≥1-grade improvement on the MFS, with most regaining independent ambulation.

Conclusions:

• Early surgical decompression within 48 hours of symptom onset is associated with superior bladder and neurological outcomes in CES patients.
• The findings underscore the need for national CES protocols and efficient referral systems, especially in resource-limited settings, to minimize diagnostic and treatment delays.