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

Overview

Journal Malays Orthop J

Specialty Orthopedics

Date 2020 Sep 28

PMID 32983384

Citations 4

Authors

A Krishnan

R Kohli

D Degulmadi

S Mayi

R Ranjan

B Dave

Affiliations

Soon will be listed here.

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.

Citing Articles

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.

Hung W, Kavishwar R, Kim H, Jie Chin B N Am Spine Soc J. 2023; 16:100290.

PMID: 38077692 PMC: 10709619. DOI: 10.1016/j.xnsj.2023.100290.

Comparison of the efficacy of fully endoscopic spine surgery using transforaminal and interlaminar approaches in the treatment of prolapsed lumbar 4/5 disc herniation.

Zhao Q, Xiao L, Wu Z, Liu C, Zhang Y J Orthop Surg Res. 2022; 17(1):391.

PMID: 35964096 PMC: 9375331. DOI: 10.1186/s13018-022-03282-3.

Outcomes of cauda equina syndrome due to lumbar disc herniation after surgical management and the factors affecting it: a systematic review and meta-analysis of 22 studies with 852 cases.

Kumar V, Baburaj V, Rajnish R, Dhatt S Eur Spine J. 2021; 31(2):353-363.

PMID: 34581849 DOI: 10.1007/s00586-021-07001-0.

Factors affecting urinary outcome after delayed decompression in complete cauda equina syndrome: "A regression model study".

Jha V, Deep G, Pandita N, Ahuja K, Ifthekar S, Kandwal P Eur J Trauma Emerg Surg. 2021; 48(2):1009-1016.

PMID: 33454810 DOI: 10.1007/s00068-020-01589-6.

References

Gu Y, Cui Z, Shao H, Ye Y, Gu A . Percutaneous transforaminal endoscopic surgery (PTES) for symptomatic lumbar disc herniation: a surgical technique, outcome, and complications in 209 consecutive cases. J Orthop Surg Res. 2017; 12(1):25. PMC: 5299691. DOI: 10.1186/s13018-017-0524-0. View

Lewandrowski K . "Outside-in" technique, clinical results, and indications with transforaminal lumbar endoscopic surgery: a retrospective study on 220 patients on applied radiographic classification of foraminal spinal stenosis. Int J Spine Surg. 2015; 8. PMC: 4325483. DOI: 10.14444/1026. View

Webb J, Gottschalk L, Lee Y, Garfin S, Kim C . Surgeon Perceptions of Minimally Invasive Spine Surgery. SAS J. 2010; 2(3):145. PMC: 2817980. DOI: 10.1016/S1935-9810(08)70032-X. View

Jha S, Tonogai I, Takata Y, Sakai T, Higashino K, Matsuura T . Percutaneous endoscopic lumbar discectomy for a huge herniated disc causing acute cauda equina syndrome: a case report. J Med Invest. 2015; 62(1-2):100-2. DOI: 10.2152/jmi.62.100. View

Rajendraprasad Dave B, Samal P, Sangvi R, Degulmadi D, Patel D, Krishnan A . Does the Surgical Timing and Decompression Alone or Fusion Surgery in Lumbar Stenosis Influence Outcome in Cauda Equina Syndrome?. Asian Spine J. 2018; 13(2):198-209. PMC: 6454274. DOI: 10.31616/asj.2018.0168. View

Li X, Dou Q, Hu S, Liu J, Kong Q, Zeng J . Treatment of cauda equina syndrome caused by lumbar disc herniation with percutaneous endoscopic lumbar discectomy. Acta Neurol Belg. 2015; 116(2):185-90. DOI: 10.1007/s13760-015-0530-0. View

Rajasekaran S, Bajaj N, Tubaki V, Kanna R, Shetty A . ISSLS Prize winner: The anatomy of failure in lumbar disc herniation: an in vivo, multimodal, prospective study of 181 subjects. Spine (Phila Pa 1976). 2013; 38(17):1491-500. DOI: 10.1097/BRS.0b013e31829a6fa6. View

Kapetanakis S, Chaniotakis C, Kazakos C, Papathanasiou J . Cauda Equina Syndrome Due to Lumbar Disc Herniation: a Review of Literature. Folia Med (Plovdiv). 2018; 59(4):377-386. DOI: 10.1515/folmed-2017-0038. View

Ahn Y, Lee H, Lee S, Lee J . Dural tears in percutaneous endoscopic lumbar discectomy. Eur Spine J. 2010; 20(1):58-64. PMC: 3036033. DOI: 10.1007/s00586-010-1493-8. View

10.

Olivero W, Wang H, Hanigan W, Henderson J, Tracy P, Elwood P . Cauda equina syndrome (CES) from lumbar disc herniations. J Spinal Disord Tech. 2009; 22(3):202-6. DOI: 10.1097/BSD.0b013e31817baad8. View

11.

Ruetten S, Komp M, Godolias G . An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine (Phila Pa 1976). 2005; 30(22):2570-8. DOI: 10.1097/01.brs.0000186327.21435.cc. View

12.

Bischoff R, Rodriguez R, Gupta K, Righi A, Dalton J, Whitecloud T . A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis. J Spinal Disord. 1993; 6(4):289-95. DOI: 10.1097/00002517-199306040-00002. View

13.

Gleave J, Macfarlane R . Cauda equina syndrome: what is the relationship between timing of surgery and outcome?. Br J Neurosurg. 2002; 16(4):325-8. DOI: 10.1080/0268869021000032887. View

14.

Srikandarajah N, Wilby M, Clark S, Noble A, Williamson P, Marson T . Outcomes Reported After Surgery for Cauda Equina Syndrome: A Systematic Literature Review. Spine (Phila Pa 1976). 2018; 43(17):E1005-E1013. PMC: 6104724. DOI: 10.1097/BRS.0000000000002605. View

15.

Tan K, Sewell M, Markmann Y, Clarke A, Stokes O, Chan D . Anterior lumbar discectomy and fusion for acute cauda equina syndrome caused by recurrent disc prolapse: report of 3 cases. J Neurosurg Spine. 2017; 27(4):352-356. DOI: 10.3171/2017.1.SPINE16352. View

16.

Mahesha K . Percutaneous endoscopic lumbar discectomy: Results of first 100 cases. Indian J Orthop. 2017; 51(1):36-42. PMC: 5296846. DOI: 10.4103/0019-5413.197520. View

17.

Gore S, Yeung A . The "inside out" transforaminal technique to treat lumbar spinal pain in an awake and aware patient under local anesthesia: results and a review of the literature. Int J Spine Surg. 2015; 8. PMC: 4325508. DOI: 10.14444/1028. View

18.

Podnar S, Trsinar B, Vodusek D . Bladder dysfunction in patients with cauda equina lesions. Neurourol Urodyn. 2005; 25(1):23-31. DOI: 10.1002/nau.20188. View

19.

Podnar S . Cauda equina lesions as a complication of spinal surgery. Eur Spine J. 2009; 19(3):451-7. PMC: 2899755. DOI: 10.1007/s00586-009-1170-y. View

20.

Gitelman A, Hishmeh S, Morelli B, Joseph Jr S, Casden A, Kuflik P . Cauda equina syndrome: a comprehensive review. Am J Orthop (Belle Mead NJ). 2008; 37(11):556-62. View