Cauda Equina in the Setting of Thoracolumbar Trauma: Is Early Decompression Indicated?

Traumatic injuries to the thoracolumbar spine are common and can be associated with a neurologic deficit. Complete cord level injury and progressive neurologic compromise have established treatment algorithms. The management of traumatic thoracolumbar spine injuries with incomplete neurologic deficits, such as cauda equina and conus medullaris syndrome, is challenging and often controversial. Published animal models and clinical data, largely retrospective, provide conflicting information as to the necessity of surgical intervention and the timing of such surgical intervention in these patients. There is a clear need for quality prospective human data to conclusively resolve the issue of timing of surgery in patients with traumatic cauda equina and conus medullaris injury.