Minimally invasive discectomy for the treatment of disc herniation causing cauda equina syndrome

Cauda equina syndrome (CES) is a condition associated with significant morbidity that requires definitive surgical decompression of the nerve roots to prevent permanent disability. Traditionally, wide open decompression has been advocated to obtain optimal decompression with minimal complications. Some have been reluctant to employ minimally invasive strategies to treat urgent conditions. The authors present a small series of four patients who presented with CES and were treated with minimally invasive discectomy (MID). Operative length times (mean±standard deviation, 102.8±30.9 minutes) were comparable to reported operative length for open laminectomies. All patients had either stabilization or resolution of symptoms at the 6-week follow-up examination. No patients suffered a cerebrospinal fluid (CSF) leak post-operatively. This series of patients presenting with CED at a single institution treated with MID demonstrates that MID can be used to successfully treat CES. Even large fragments can be safely removed without increased risk of a CSF leak.