# Functional Outcomes in Cauda Equina Syndrome Beyond 48 hours Window: A Case Series

## TL;DR

This case series shows that patients with cauda equina syndrome can still improve after delayed surgery, with recovery of bladder and limb function over time.

## Contribution

The study provides evidence of functional recovery in CES patients beyond the typical 48-hour surgical window.

## Key findings

- All patients showed significant postoperative improvement in bladder function and lower limb strength.
- Bladder sensation recovery began within 5–20 days post-surgery, with full recovery between 10 and 120 days.
- Meaningful recovery is possible even with delayed surgical intervention in CES cases.

## Abstract

Cauda equina syndrome (CES) results from compression of the cauda equina (CE) nerve roots and presents with a spectrum of neurological deficits. We report four cases of CES with symptom durations ranging from 3 days to 1 month at presentation. The clinical features included urinary incontinence, reduced perianal sensation, lower limb weakness, and erectile dysfunction in select cases. Despite delays in surgical intervention for some patients, all demonstrated significant postoperative improvement in bladder function and lower limb strength. Bladder sensation began to recover within 5–20 days postoperatively, with complete bladder function restoration achieved between 10 and 120 days. While early surgical decompression remains the standard for optimal outcomes, these cases suggest that meaningful recovery is still possible following delayed intervention. Prompt diagnosis and timely surgery, even in late-presenting cases, may improve functional outcomes. Our series reports early postoperative timelines for recovery and aligns observations with key domains from CES core outcome set in low- and middle-income countries.