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.
Highlights
To analyse the results of Cauda Equina Syndrome (CES) operated by Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD)
There are high chances of residual disabilities of limb and/or bladder and/or sexual dysfunction leading to unhappiness and medico-legal litigations[3,6]
The use of Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD) for treating CES is sparsely mentioned in the literature[7,8,9,10,11,12,13]
Summary
To analyse the results of Cauda Equina Syndrome (CES) operated by Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD). 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. Cauda equina syndrome (CES) is one of the most serious and complicated spinal pathologies[1,2] It has been reported as the extreme presentation of 1-3% of Lumbar Disc Herniation (LDH) patients[2,3,4]. The advantages of PTELD are the use of local anaesthesia, day-care, least pain, speedy recovery, preservation of muscles, stability, low blood loss, and minimal post-operative complications[8,9,10,13,14]
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