Cauda Equina Syndrome with Intradural Disc Extrusion: A Case Report

Recurrent lumbar disc herniation occurs in approximately 5%–15% of patients following discectomy, and among these patients, lumbar spinal stenosis is concurrently present in about 20%–30%. Traditional treatments such as repeat discectomy or spinal fusion, although effective, are invasive procedures associated with higher complication rates and extended recovery periods. Recent advancements in endoscopic spine surgery techniques, specifically unilateral biportal endoscopic (UBE) laminotomy with bilateral decompression (ULBD) and percutaneous endoscopic lumbar discectomy (PELD), provide less invasive treatment alternatives. In this technical report, 2 patients with multilevel lumbar pathologies underwent a hybrid surgical approach combining UBE-ULBD and PELD, resulting in successful decompression and pain-free discharge. These endoscopic methods allow effective removal of disc fragments and calcifications with minimal tissue disruption, while continuous intraoperative irrigation ensures clear visualization, reduces bleeding, and minimizes infection risk. This staged endoscopic approach addresses adjacent-level pathologies in a single surgical session, significantly reducing recovery time and complications compared to traditional open surgical procedures. As endoscopic spine surgery continues to advance, precise surgical planning and specialized training remain critical for optimal patient outcomes, emphasizing the potential of these minimally invasive techniques in managing complex lumbar spine conditions.