Indications for Emergency Surgical Treatment

  • Max JägersbergEmail author
  • Enrico Tessitore


Indications to emergency surgical treatment in degenerative spinal conditions are limited to those conditions where a delay in surgical management may lead to potentially catastrophic and irreversible sequelae. Indeed, those conditions are rarely encountered during clinical practice. The most typical scenarios in the thoraco-lumbar region are cauda equina syndrome (CES) and progressive radicular motor deficit (PRMD), both primarily caused by degenerative lumbar pathology. Early surgical treatment may influence the partial or full recovery and the long-term outcome of concerned patients.


  1. 1.
    Fraser S, Roberts L, Murphy E. Cauda equina syndrome: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil. 2009;90(11):1964–8.CrossRefGoogle Scholar
  2. 2.
    Council MR. Aids to the examination of the peripheral nervous system Memorandum No. 45 (superseding War Memorandum No. 7). Her Majesty’s stationary office. 1976.Google Scholar
  3. 3.
    Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine (Phila Pa 1976). 2000;25(12):1515–22.CrossRefGoogle Scholar
  4. 4.
    Korse NS, Veldman AB, Peul WC, Vleggeert-Lankamp CLA. The long term outcome of micturition, defecation and sexual function after spinal surgery for cauda equina syndrome. PLoS One. 2017;12(4):e0175987.CrossRefGoogle Scholar
  5. 5.
    Arts MP, Peul WC, Koes BW, Thomeer RT, Leiden-The Hague Spine Intervention Prognostic Study (SIPS) Group. Management of sciatica due to lumbar disc herniation in the Netherlands: a survey among spine surgeons. J Neurosurg Spine. 2008;9(1):32–9.CrossRefGoogle Scholar
  6. 6.
    Overdevest GM, Vleggeert-Lankamp CL, Jacobs WC, Brand R, Koes BW, Peul WC, Leiden-The Hague Spine Intervention Prognostic Study Group. Recovery of motor deficit accompanying sciatica--subgroup analysis of a randomized controlled trial. Spine J. 2014;14(9):1817–24.CrossRefGoogle Scholar
  7. 7.
    Peul WC, van Houwelingen HC, van den Hout WB, Brand R, Eekhof JA, Tans JT, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245–56.CrossRefGoogle Scholar
  8. 8.
    Takenaka S, Aono H. Prediction of postoperative clinical recovery of drop foot attributable to lumbar degenerative diseases, via a Bayesian network. Clin Orthop Relat Res. 2017;475(3):872–80.CrossRefGoogle Scholar
  9. 9.
    Macki M, Syeda S, Kerezoudis P, Gokaslan ZL, Bydon A, Bydon M. Preoperative motor strength and time to surgery are the most important predictors of improvement in foot drop due to degenerative lumbar disease. J Neurol Sci. 2016;361:133–6.CrossRefGoogle Scholar
  10. 10.
    Aono H, Nagamoto Y, Tobimatsu H, Takenaka S, Iwasaki M. Surgical outcomes for painless drop foot due to degenerative lumbar disorders. J Spinal Disord Tech. 2014;27(7):E258–61.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, University Medical Center MainzMainzGermany
  2. 2.Department of Neurosurgery, Faculty of MedicineUniversity of GenevaGenevaSwitzerland

Personalised recommendations