This second group can often pose more of a diagnostic challenge. Symptoms may be misinterpreted in this group as simply an exacerbation of previous back complaints or urinary changes secondary to aging. Patient underwent emergent decompression and complete recovery of neurologic function. Review of the Literature Cauda equina syndrome is considered an absolute indication for decompression. However, the timing of this decompression, particularly in the presence of an acute disc herniation, is not clear in the literature and is a topic of considerable debate.
Many authors favor urgent and even emergent surgical intervention.
Early studies recommended surgical decompression within 6 hours to maximize neurologic recovery. Patients with stenosis or burst fracture were excluded. The timing of surgical intervention ranged from less than 24 hours to more than 30 days. The author also noted a trend toward a decrease in chronic sciatic-type pain in those decompressed early. Shapiro noted an overall improvement in outcome even if the decompression was performed late, although the degree of improvement was less than with early decompression.