Cauda Equina Syndrome: Is It a Surgical Emergency?

Cauda equina syndrome is defined as the compression of the nerve roots distal to L1 secondary to acute disc herniation, bony fragments, tumor, infection, or postsurgical intervention. The result is a complex of symptoms consisting of low back pain, unilateral or bilateral sciatica, motor weakness of the lower extremities, sensory disturbances, and loss of bowel or bladder function. The literature is clear that the early diagnosis of this entity is crucial and may be difficult, particularly if the patient does not present with all of the aforementioned signs and symptoms. Conversely, the literature is unclear as to the optimal timing of intervention. Discussion in the literature ranges from the need for emergent early decompression to no adverse effects from delayed decompression. This discussion reviews the current literature and attempts to draw a conclusion about the optimal timing for surgical intervention in patients with cauda equina syndrome.