Percutaneous Endoscopic Interlaminar Lumbar Discectomy for Treating Acute Cauda Equina Syndrome: A Case Series of 25 Patients

Abstract Cauda equina syndrome (CES) is caused by compression of nerves in the lumbar spine below the conus medullaris. Symptoms include progressive weakness in the lower extremities, back pain with sciatica, saddle anesthesia, and urinary or bowel dysfunction. These symptoms vary in intensity and onset, and can sometimes be an emergency. The standard surgical procedure for CES typically involves a microscope-assisted interlaminar decompression with laminotomy and sequestrectomy, with or without partial, rather than complete, discectomy. However, endoscopic spine surgery was introduced as an alternative method in the treatment of CES. We aimed to evaluate the feasibility and clinical efficacy of percutaneous endoscopic interlaminar lumbar discectomy (PEILD) for the treatment of CES. A retrospective study of 25 patients with CES who underwent PEILD surgery from May 2017 to April 2022 at our institution, and the data were collected and retrospectively analyzed. All patients complained of incomplete or complete cauda equina manifestations. These patients may have one or more lumbar disc herniations and unilateral or bilateral nerve root compression. We used clinical examination, Macnab criteria, Oswestry Disability Index (ODI) score, and Visual Analog Scale (VAS) score to evaluate the outcome. A total of 25 patients with a mean age of 38.32 years (range 18–60 years) were included in our study. Of these 25 patients, 16 were males (64%), and 9 were females (36%), with an average follow-up of 1 year. The main complaint was sciatica, hypoesthesia (including saddle hypoesthesia and anesthesia), weakness, impotence, and sphincteric disturbance (including urinary hesitancy, urgency, frequency, or retention). We performed PEILD in all patients. About 20 patients had no postoperative complications (80%). The most common complications were superficial wound infection, cerebrospinal fluid (CSF) leak, pseudomeningocele, and discitis. The preoperative mean ODI score for low back pain for our patients was 61.76%. One year postoperatively, the mean ODI score improved to 13.36%. The preoperative mean VAS score for leg pain was 6.47. One year after surgery, the mean VAS score significantly decreased to 1.81. PEILD as a minimally invasive surgery could be considered a valid surgical option for treatment of different stages of CES; however, it has a steep learning curve and needs high surgical experience to ensure adequate decompression, especially in complete CES.