Evolution of the Surgical Management of Cauda Equina Syndrome

Abstract

Cauda equina syndrome arises secondary to lumbosacral nerve root entrapment, mostly a result of lumbar disc herniation. Clinically, it manifests as sciatica, saddle anesthesia, lower limb weakness, and bowel/bladder dysfunction. Surgical management has developed significantly over the past decades. This literature review aims to shed light on surgical interventions for this condition. Results from 22 original articles have been summarized. Most authors advocate for emergency surgical intervention in all cases.  Surgery is performed via an open or endoscopic technique. Open surgery involves lumbar discectomy with laminectomy. It can be carried out with a conventional operative microscope. In contrast, endoscopic discectomy utilizes a minimally invasive incision that minimizes blood loss and the duration of hospital stay. Recent radiologic advances including intraoperative X-ray fluoroscopy, CT scan and ultrasonography have also markedly improved surgical outcomes for lumbar discectomy.