How Important is timing of Surgery in Cauda Equina Syndrome?

How important is timing of surgery in Cauda Equina Syndrome (CES)?

Answer:It means everything! The most important issue of CES is timing!

When i was looking for information about CES when i was first diagnosed i kept reading the same theme in all the sourced material. It consistently referred to this 48 hour 'window of opportunity'. Decompression surgery performed within this time frame offered the most likely potential for return of function.

In 2003, Hussain and colleagues reviewed 20 CES patients, 6 of whom presented within 48 hours of symptom onset and underwent surgery within 5 hours.
There was no significant difference in urologic outcome or overall quality of life between patients who were decompressed within 48 hours and patients who were decompressed after 48 hours.

Further studies were since carried out on a larger number of patients, some were operated on within the 48 hours and some 2 to 10
days, 11 days to 1 month, and more than 1 month.
Studies showed that those operated on within 48 hours either made a full recovery or almost full recovery. As the time became longer between the onset of CES and surgical intervention the recovery and return of function was significantly less.

It is considered that if the CES has become complete (CESR) then timing does not improve the prognosis, surgical intervention is still necessary but does not tend to offer the opportunity for returning function.

I am presuming from my understanding that at this point the damage is beyond repair....although,  if the patient is still at the incomplete stage (CESI) Then the potential is there for return of some function even with a longer delay although it will be unlikely to be as promising an outcome.

I have linked my post that explains Complete CES (CESR) and Incomplete CES (CESI), please click on the link to read
inspiredsciforum.com/thread/281/equina-syndrome-classification-complete-incomplete