Cauda Equina Syndrome: Poor Recovery Prognosis Despite Early Treatment

Alexia Planty-Bonjour, MD; Gaelle Kerdiles, MD; Patrick François, MD, PhD; Christophe Destrieux, MD, PhD; Stephane Velut, MD, PhD; Ilyess Zemmoura, MD, PhD; Ann-Rose Cook, MD; Louis-Marie Terrier, MD; Aymeric Amelot, MD, PhD


Spine. 2022;47(2):105-113. 

In This Article


CES remains a very disabling and mutilating syndrome with a significantly dark motor, urinary, and bowel prognosis for patients that remain young. The functional prognosis is poor, and few patients can return to work. The prognostic factors identified were mainly the initial severity of motor deficits. We believe that the characteristic of complete/incomplete CES should no longer be used since it has no impact on the recovery and the definition of the syndrome is ambiguous. The timing to intervention following CES is debated: our series as well as the previous studies have not clearly shown a timeframe for good recovery. Decompression should be done as early forward as possible.

Furthermore, as you pointed out, the only way to prevent CES is to educate the patient: 1) By instructing to look out for clinical signs that require immediate consultation: motor deficit, genito-sphincter disorders, and severe pain; 2) By teaching patients to search for these signs through self-examination and during everyday practices (intimate hygiene, intimate relationship); and 3) By identifying patients: since the main etiology of CES is a herniated disc, as far as we are concerned in our department, all patients who present a nonsurgical herniation are followed, informed, and educated to hunt down the signs of CES.