This 2008 JAAOS narrative review covers the epidemiology, pathophysiology, clinical presentation, workup, and surgical management of cauda equina syndrome (CES), with particular attention to the diagnostic pitfalls in postoperative spine patients and the contested question of optimal surgical timing.
When a postoperative spine patient reports increasing back or leg pain that doesn't respond to analgesia — especially with any difficulty voiding — treat it as early CES until proven otherwise: get emergent MRI and plan decompression within 48 hours, because that window is where the outcome data show benefit.
Don't let a urinary catheter mask urinary retention, and don't attribute new neurologic symptoms to normal postoperative discomfort.
This 2008 JAAOS narrative review covers the epidemiology, pathophysiology, clinical presentation, workup, and surgical management of cauda equina syndrome (CES), with particular attention to the diagnostic pitfalls in postoperative spine patients and the contested question of optimal surgical timing.
When a postoperative spine patient reports increasing back or leg pain that doesn't respond to analgesia — especially with any difficulty voiding — treat it as early CES until proven otherwise: get emergent MRI and plan decompression within 48 hours, because that window is where the outcome data show benefit.
Don't let a urinary catheter mask urinary retention, and don't attribute new neurologic symptoms to normal postoperative discomfort.