Complications
At surgical outpatient follow-up, check for any ongoing urinary symptoms and refer to the appropriate specialist service if present.[15] Depending on local protocols, this may be an incontinence, urology, or spinal cord injury service.[15][16][65]
Bladder/lower urinary tract dysfunction has been reported at follow-up for between 38% and 76% of patients after surgery for CES.[45][64] Symptoms include overactive bladder, stress incontinence, and low stream.[45] It is more common in patients who had CES with retention before surgery than in those with incomplete CES.
If bladder catheterisation is needed, an intermittent catheter is preferred, as it is associated with lower rates of urinary tract infection and urethral trauma.[53][54][55][56] An indwelling catheter may be used if intermittent catheterisation is not feasible.[53][54] Anticholinergic medications are often part of management. Invasive procedures may be considered for ongoing problems.[53][54]
In one study, 70% of patients who had surgery for CES reported pain at follow-up (mean follow-up 43 months), most of whom had back pain.[45] Referral to pain management services should be considered for patients whose pain is significantly affecting their day-to-day lives.
For management of chronic pain (>3 months post-surgery for CES), do NOT offer opioids, gabapentinoids, anticonvulsants, oral corticosteroids, or benzodiazepines.[15]
In one study, 70% of patients who had surgery for CES reported sensory loss at follow-up (mean follow-up 43 months).[45]
Bowel dysfunction has been reported at follow-up for between 13% and 43% of patients after surgery for CES.[45][64]
Ongoing neurogenic bowel problems can include involuntary bowel movements, constipation, and impaction.[57][58]
Patients with bowel dysfunction resulting from injury to the cauda equina may have areflexic (flaccid) bowel dysfunction in the short or long term, although mixed reflex and areflexic dysfunction is also possible.[58]
At surgical outpatient follow-up, check for any ongoing bowel symptoms and, if present, refer to a bowel programme for individualised rehabilitation and ongoing management.[15][57][58][59] This may be provided by the continence, colorectal, or spinal cord injury service; check local protocols.[16]
A bowel programme can help to establish regular stimulation of the bowels to cause a bowel movement. This will help to prevent involuntary bowel movements, constipation, and impaction.
Laxatives and/or bowel evacuation may also be required.[57][59]
If bowel evacuation is required, patients should be taught how to undertake digital rectal stimulation (DRS) followed by digital rectal evacuation (DRE).[15]
Sexual dysfunction has been reported at follow-up for between 39% and 56% of patients after surgery for CES.[31][64] However, it is often not assessed or documented at follow-up.[45]
Ensure that all patients are offered advice on the potential for sexual dysfunction following surgery for CES, and ask specifically about this at postoperative follow-up.[15]
In one study, 44% of patients who had surgery for CES reported leg weakness at follow-up (mean follow-up 43 months), including 13% who needed a walking aid to mobilise.[45]
Many patients experience psychological issues after CES.
All patients can benefit from being informed about relevant support groups. In the UK, examples include the Cauda Equina Champions Charity and the Spinal Injuries Association.[15] Cauda Equina Champions Charity Opens in new window Spinal Injuries Association Opens in new window
Those with ongoing disability should be offered psychological support, according to the local pathway. In the UK, this is typically provided by the spinal cord injury service.[15]
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