Percutaneous Endoscopic Lumbar Discectomy as an Emergent Surgery for Cauda Equina Syndrome Caused by Lumbar Disc
Changhong Chen1, Pan Fan2, Lei Huang3
1Department of Orthopedics, Affiliated Zhongda Hospital of Southeast University, Nanjing Jiangsu, P.R. China; Department of Orthopedics, Jiangyin Affiliated Hospital of Nanjing Chinese Medicine University, Wuxi City, Jiangsu Province, P.R. China; Department of Orthopaedic Surgery, New York University Medical Center, New York, NY, USA.
Insights
Percutaneous endoscopic lumbar discectomy (PELD) offers a minimally invasive surgical option for Cauda Equina Syndrome (CES) caused by lumbar disc herniation (LDH). This approach leads to significant recovery of neurological deficits and satisfactory outcomes for patients.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Minimally Invasive Spine Surgery
Background:
- Cauda Equina Syndrome (CES) is a rare but serious condition necessitating urgent surgical intervention to mitigate neurological damage.
- Lumbar Disc Herniation (LDH) is a primary cause of CES, accounting for 1-3% of all disc herniation cases.
Purpose of the Study:
- To evaluate the clinical characteristics and treatment outcomes of patients experiencing CES secondary to LDH.
- To assess the efficacy of Percutaneous Endoscopic Lumbar Discectomy (PELD) as an emergent surgical treatment for CES caused by LDH.
Main Methods:
- A retrospective study was conducted on patients treated for CES due to LDH with emergent PELD between January 2015 and March 2018.
- Key variables analyzed included patient demographics, disc prolapse level, diagnostic-to-surgical interval, and neurological deficits (lower extremity pain/weakness, perianal sensation, anal contraction, bladder function).
- Follow-up assessments focused on the reversal of these neurological deficits.
Main Results:
- All patients undergoing emergent PELD demonstrated complete or partial recovery of lower extremity symptoms, with only one case of residual weakness at one year.
- Perianal sensation showed improvement, with 9 cases fully recovering and 2 partially recovering at the one-year follow-up.
- No patients experienced persistent anal contraction or bladder dysfunction one year post-surgery.
Conclusions:
- Percutaneous Endoscopic Lumbar Discectomy (PELD) serves as an effective minimally invasive surgical option for emergent treatment of CES caused by LDH.
- PELD facilitates adequate decompression of the herniated disc, leading to satisfactory neurological recovery and functional outcomes in patients with CES.
- Further research with larger patient cohorts and extended follow-up periods is warranted to solidify these findings.
Background:
Cauda equina syndrome (CES) is a rare and serious syndrome that requires urgent surgery to improve neurological symptoms. CES can be caused by lumber disc herniation (LDH) and accounts for about 1% to 3% of all cases of disc herniation.
Objectives:
The purpose of this study was to analyze the characteristics and outcomes of the cases of patients with CES caused by LDH and treated by percutaneous endoscopic lumbar discectomy (PELD).
Study Design:
This study used a retrospective design.
Setting:
Research took place at the Jiangyin Hospital affiliated with Nanjing University of Chinese Medicine, Jiangsu, China.
Methods:
This was a retrospective study of patients treated for CES due to LDH with PELD as an emergent surgery at a single institutional department between January 2015 and March 2018. The following variables were analyzed: age, gender, the level of disc prolapse, time interval between diagnosis and surgery, lower extremity pain or weakness, perianal sensation, voluntary anal contraction, presence of bladder dysfunction, and the reversal of these deficits in follow-up.
Results:
After the emergent surgery with PELD, the lower extremity symptoms were all completely recovered or partly decreased. Only one patient had weakness with plantar flexion of the left foot at the one-year time point. The decreased perianal sensations were partly recovered after surgery, and 9 cases had complete recovery and 2 cases had partial recovery at the one-year follow-up. No patients had anal contraction and bladder problems after the one-year follow-up.
Limitations:
The number of cases reported here is limited, so we will expand the study by including an increased number of patients and a longer follow-up duration.
Conclusion:
Taken together, these observations show that PELD, used as a minimally invasive choice of emergent surgery, can provide enough decompression of disc prolapse and a satisfactory outcome for patients with CES caused by LDH.
Key Words:
Cauda equina syndrome, lumbar disc herniation, outcomes, percutaneous endoscopic lumbar discectomy.
