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

Abstract

BACKGROUND: Cauda equina syndrome (CES) is a rare but an important emergent state caused by compression of lumbosacral nerve roots. Conventionally, the treatment of CES patients was total laminectomy and discectomy. It has been reported that minimally invasive lumbar microscopic discectomy (MIS-LD) led to outcomes comparable to conventional open microdiscectomies, with fewer complications. OBJECTIVE:This IS study aimed to assess the effectiveness of minimally invasive lumbar microscopic discectomy for treatment of huge or ruptured lumbar disc herniation (LDH) causing CES. METHODS:This is observational retrospective case series of 12 patients treated for CES due to huge/ruptured LDH with MIS-LD. Patient's demographics and outcomes included visual analogue scale (VAS) and Medical Research Council (MRC) grading scale for low back pain (LBP), and sciatica, and lower limbs motor power assessment, respectively. Oswestry disability index (ODI) for pain and weakness as functional score. Postoperative follow up continued for 18 months to evaluate recovery of sciatica, motor weakness, urinary/bowel functions, saddle area sensory changes and sexual dysfunction. RESULTS:All patients were males, aged 28-59 years with mean age ± standard deviation (SD) of 43.14±4.2 years. Operative time ranged from 90minutes-3hours with mean time ± SD of 132.86±35minutes. Sciatica improved immediately, urinary and bowel functions recovered completely within weeks in all patients (100%), lower extremity weakness improved after 1-3 months in 11 patients (92%), and sexual dysfunction improved from 8-10 weeks in all patients (100%). Finally, saddle area sensation returned to normal after six months in all affected patients (100%). CONCLUSION:Minimally invasive lumbar microscopic discectomy is effective and efficient procedure for treatment of CES caused by huge/ruptured LDH with good recovery of motor power, full control of urinary, bowel and sexual functions, and normal saddle sensation, without surgical side effects.