Beyond Surgery: Navigating Postoperative Care for Cauda Equina Syndrome Through a Scoping Review

Abstract

Objective: Cauda equina syndrome (CES) is a serious neurological injury that can result in permanent disability. Our objective was to review the evidence for rehabilitation strategies for CES in a scoping review.

Methods: A scoping review of the literature to identify rehabilitation strategies and their outcomes was performed. The search strategy used was: (Cauda equina syndrome) AND (treatment OR management OR intervention OR physio∗ OR bladder∗ OR neuro∗ OR stem cell OR repair OR rehab∗) AND ("post?operat∗ OR post?surgical OR surgery"). MEDLINE, CINHAL, Prospero, Cochrane, ClinicalTrials.gov, EMBASE, Web of Science, PEDro, and eThos were searched.

Results: Eight studies of rehabilitation for CES were identified which assessed general rehabilitation, active rehabilitation in a spinal cord injury unit, multidisciplinary team involvement and follow-up, spinal manipulation, spinal cord stimulation, and sacral nerve stimulation. Outcome measures used were inconsistent, study quality was low, and it was difficult to draw conclusions regarding the effectiveness of rehabilitation strategies.

Conclusions: Despite the risk of devastating injury and a recent Getting It Right First Time pathway recommending rehabilitation post CES surgery, there is very limited literature on rehabilitation for CES. Future high-quality rehabilitation trials following CES surgery are needed to guide treatment decisions and optimize postsurgical outcomes.

Keywords: Cauda equina syndrome; Nervous system disease; Spinal cord injury.