Cauda Equina Syndrome: A Review of 15 Patients Who Underwent Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD) Under Local Anaesthesia

Abstract

Introduction: To analyse the results of Cauda Equina Syndrome (CES) operated by Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD). Material and Methods: The study is a retrospective series of 15 patients operated by PTELD. Bladder dysfunction was classified as incomplete CES (CESI) and complete CES retention (CESR). Bladder / motor recovery rate and its timing, Oswestry Disability Index (ODI), Visual Analogue Score (VAS), patient satisfaction index, and sexual dysfunction were used to measure the outcome objectively. Additionally, in CESR patients, post-void residual (PVR) urine was measured by sonography. Complications and technical problems were noted. Results: There were ten patients of CESI and five patients of CESR. The average follow-up was 20.33(12.05) months. Bladder symptoms recovery was 100%, and motor recovery was 80%. VAS for back pain recovered to 0.53(0.52) from 8(2.39). VAS for leg pain recovered to 0.13(0.35) from 9.20(1.32). ODI improved to 6.07(2.85) from 77.52(13.20). The time to the recovery of bladder function was 1.47(1.55) days. All CESR patient’s abnormal PVR urine was normalised at five weeks post-operative. No complications were reported. However, five technical executional problems occurred. Conclusion: PTELD can be considered for CES treatment due to its substantial and quick recovery advantages. However, more evidence support is needed to make it a practice recommendation.

Postoperative Lumbar Spondylodiscitis Following Transforaminal Endoscopy and Outcomes of Transforaminal Lumbar Interbody Fusion

“…The surgical variables are tabulated (Table 3). The preoperative VAS for leg pain was 5.78±4.19 (6)(7)(8)(9)(10), which improved to 0.84±0.60 follow-up (VAS score bar diagram Figure 1). The preoperative ODI score was 87.01±7.70 (73.33-97.78) which improved to 7.36±8.14 (0-26.67) at final follow-up.…”

“…Comorbid elderly, immunosuppression, renal failure, and diabetes mellitus are some of the risk factors that cannot be changed in POS pathogenesis, but obesity, smoking, invasive catheter, and prolonged hospital timing are the ones that can be changed [38][39][40]. Thorough, improved irrigation mixed with saline, and antibiotics in TELD leads to reduced POSe [10,17]. Diagnosis can get delayed or difficult in early presentation, and a high index of suspicion is needed [37].…”

Technical feasibility of combined uniportal unilateral laminotomy with bilateral decompression and interlaminar lumbar discectomy surgery for cauda equina syndrome due to lower lumbar disc herniation

“…Performing PTELD (percutaneous transforaminal endoscopic lumbar discectomy) under local anesthesia can have medicolegal implications [ 40 ]. Under local anesthesia, the patient can become nervous, anxious, and even move intraoperatively, increasing the operative time [ 41 ], and pain experienced by the patient poses various challenges to successfully completing the operation [ 42 ].…”

“…In their study, Krishnan et al. [ 40 ] also performed postoperative MRI to confirm decompression in all patients undergoing transforaminal discectomy for cauda equina syndrome. We also understand the financial constraints of doing post-operative MRI in every patient.…”

Minimally Invasive Microscopic Lumbar Discectomy for Treatment of Cauda Equina Syndrome, Is It Effective?

“…1,2 Etiology of CES may be due to spine trauma, pathological spine fracture or rare spinal epidural or subdural hematoma, but massive LDH is considered the most common cause of CES. 3,4 It has been reported that CES presents only in 1-3% of LDH patients. 5 According to Fraser et al, diagnosis of CES is made if patient has one or more of the following symptoms; saddle area dysesthesia or anesthesia (diminished or loss of sensation over the perineum, buttocks, and inner thighs, urinary or bowel sphincteric disturbances, sexual dysfunction, with either presence of sciatica and lower limbs neurological motor deficit or not.…”