Treatment of cauda equina syndrome caused by lumbar disc herniation with percutaneous endoscopic lumbar discectomy

Abstract

To evaluate the feasibility and clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) for cauda equina syndrome (CES) caused by disc herniation. 16 patients with CES caused by LDH at the early and middle stages of Shi's classification were selected as the objects of study, who underwent PELD. Clinical outcomes were assessed using the Macnab criteria and the visual analogue scale (VAS). The VAS for leg pain and back pain significantly decreased from preoperative scores of 7.67 ± 1.23 and 7.52 ± 1.42, respectively, to postoperative scores of 1.71 ± 0.53 and 3.18 ± 0.72. Thirteen patients showed favorable results. Complications included one patient of motor weakness, and one patient developed an ipsilateral recurrent herniation who finally acquired satisfactory result after reoperation. Hence, PELD could be used as an alternative surgical method for the treatment of CES in properly selected cases and appropriate patient selection and a reasonable surgical approach will give rise to better outcomes.

Cauda Equina Syndrome Due to Lumbar Disc Herniation: a Review of Literature

“…3,5,8,14,19,28,41 According to the literature, a wide laminectomy and the extensive decompression of the nerves of CES is one of the methods which are the "key role" in the treatment of CES. 1,8,12,25,27,29,45 Several authors report that a removing of the disc space material "takes place" after the decompression.…”

“…It is a minimal invasive surgery under local anesthesia, known as endoscopic and provides huge expectancies for the treatment of CES. 14 Generally, CES due to LDH is an urgent surgical situation. The timing of surgical technique is related to the prognosis of CES.…”

“…The sciatica can either be unilateral or bilateral. 14,24,25,34 The pain of the sciatica extends from the lower back to the legs. At the level of L5-S1, the damages of these nerve roots constitute the most frequent case of sciatica.…”

“…11,29,30 CES due to lumbar disc herniation composes 1-3% of all herniated lumbar discs. [9][10][11][12][13][14]16,17,27,36 Concerning the literature, 45% of the cases of CES are caused by lumbar disc herniation. Moreover, 2-6% of lumbar disc operations cause CES.…”

“…CES due to LDH is 1-3% of all disc herniations. [8][9][10][11][12][13][14][15][16][17] There are also other causes that lead to CES such as an accident that injured the spine, complications with spinal anesthesia, drug side effects and vascular lesions of the spinal cord. 5,9,18,19 Patients usually present symptoms such as low back pain with unilateral or bilateral sciatica, reduced sensation in the saddle area, reduction of sexual function, fecal incontinence, bladder dysfunction, muscular weakness in legs and sensory loss in the perineum, buttocks and upper posterior thighs.…”