1271 - Turning the Tide: Non-Surgical Success in Managing Cauda Equina Syndrome

An 80-year-old man presented to the emergency department with progressive lower extremity weakness, unsteady gait, and urinary symptoms, including dysuria, mild incontinence, and one episode of bowel incontinence over the past 2–3 weeks. He reported increasing leg heaviness and weakness, resulting in instability and multiple falls at home. Initial intervention with a Foley catheter alleviated his urinary discomfort, and a urine culture revealed a urinary tract infection caused by Escherichia coli. His neurological examination indicated lower extremity weakness, sensory deficits in the saddle region, diminished reflexes, and gait disturbance—findings consistent with Cauda Equina Syndrome (CES). Lumbar spine imaging confirmed significant L4-L5 stenosis with cauda equina compression. Given his age and mild CES presentation, conservative management was selected, with high-dose dexamethasone and inpatient rehabilitation to enhance strength and stability.

Discussions: This case highlights the effectiveness of a conservative approach for CES in elderly patients, especially when some neurological function remains below the level of compression. By avoiding surgery, the patient circumvented the risks commonly associated with operative interventions in older adults, including prolonged recovery and potential complications. Symptom management was achieved through corticosteroids and gabapentin, paired with a structured rehabilitation program focused on strength and gait. The decision to forgo surgery likely contributed to a quicker recovery, allowing the patient to regain mobility and independence sooner.

Conclusions: In conclusion, this case demonstrates the value of individualized treatment strategies, particularly for elderly patients with mild CES. When symptoms are manageable, a non-surgical approach can offer safe and effective results without the additional burdens of surgery. This case serves as a reminder to carefully weigh the necessity of surgical intervention in elderly patients, as conservative care can often achieve favorable outcomes while minimizing risk.