When is surgical decompression indicated in the treatment of cauda equina and conus medullaris syndrome?

Updated: Jun 14, 2018
  • Author: Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM; Chief Editor: Nicholas Lorenzo, MD, CPE, MHCM, FAAPL  more...
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In acute compression of the conus medullaris or cauda equina, surgical decompression as soon as possible becomes mandatory. The goal is to relieve the pressure on the nerves of the cauda equina by removing the compressing agent and increasing the space in the spinal canal. Traditionally, cauda equina syndrome has been considered a surgical emergency, with surgical decompression considered necessary within 48 hours after the onset of symptoms, and preferably performed within 6 h of injury. [61, 96, 97, 98]

For patients in whom a herniated disk is the cause of cauda equina syndrome, a laminotomy or laminectomy to allow for decompression of the canal is recommended, followed by gentle retraction and discectomy.

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 neurological damage.

Surgical treatment may be necessary for decompression or tumor removal, especially if the patient presents with acute onset of symptoms. Surgical treatment may include laminectomy and instrumentation/fusion for stabilization or discectomy. Other surgical care may entail wound care (eg, debridement, skin graft, and skin flap/myocutaneous flap).

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