scholarly journals Percutaneous Endoscopic Lumbar Discectomy for a Huge Herniated Disc Causing Acute Cauda Equina Syndrome: A Case Report

2015 ◽  
Vol 62 (1.2) ◽  
pp. 100-102 ◽  
Author(s):  
Subash C. Jha ◽  
Ichiro Tonogai ◽  
Yoichiro Takata ◽  
Toshinori Sakai ◽  
Kosaku Higashino ◽  
...  
Keyword(s):  
Case Report ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Herniated Disc ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Endoscopic Lumbar Discectomy

scholarly journals Percutaneous Endoscopic Lumbar Discectomy as an Emergent Surgery for Cauda Equina Syndrome Caused by Lumbar Disc Herniation

2020 ◽  
Vol 3;23 (6;3) ◽  
pp. E259-E264
Author(s):  
Yuntao Wang
Keyword(s):  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
One Year ◽  
The One ◽  
Endoscopic Lumbar Discectomy ◽  
Emergent Surgery

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

scholarly journals ADVANTAGES AND WEAKNESSES OF PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY: ALGORITHM SELECTION

2018 ◽  
Vol 17 (3) ◽  
pp. 200-205
Author(s):  
Artem Gushcha ◽  
Andrey Vershinin ◽  
Sergey Arestov ◽  
Alexey Kashcheev ◽  
Vladimir Tjurnikov ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Surgical Treatment ◽  
Lumbar Discectomy ◽  
Herniated Disc ◽  
Treatment Level ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Advantages And Disadvantages ◽  
Endoscopic Method ◽  
Microendoscopic Discectomy ◽  
Endoscopic Lumbar Discectomy

ABSTRACT Objective: Degenerative diseases of the spine are the most common disorder seen in the practice of the neurosurgeon. According to many surgeons, microdiscectomy is the “gold standard” of surgical treatment. Analyzing the current literature, it is seen that the use of endoscopic techniques in spinal surgery is increasing. However, due to the lack of detailed information on the advantages and disadvantages of these methods, there is a need for continuing research in this area. Work to clarify the features of these methods, their specificity and algorithmization will increase the effectiveness of surgical treatment. Methods: This study included patients with herniated lumbar intervertebral discs, the presence of pain in the leg, and failed of conservative therapy. In the period 2014 to 2017, 172 endoscopic lumbar discectomies were performed, using microendoscopic discectomy and percutaneous endoscopic lumbar discectomy. The effectiveness of each technique was evaluated through comparative analysis. Results: In both groups, the methods used obtained high efficacy rates. Comparative analysis showed the advantages of the percutaneous technique in terms of shortening the return to normal activity time, hospitalization time, and disability, and reducing back pain in the early postoperative period. On the other hand, the microendoscopic discectomy enabled greater radicality to be achieved in cases with herniated disc ossification and complex anatomy of the vertebral segment. Conclusions: Analysis of the data obtained led to the formulation of an algorithm for selecting the optimum endoscopic method for achieving positive results of surgical treatment. Level of Evidence II; Therapeutic studies, investigating the results of treatment.

scholarly journals Percutaneous Endoscopic Lumbar Discectomy for L5-S1 Disc Herniation: Consideration of the Relation between the Iliac Crest and L5-S1 Disc

2016 ◽  
Vol 19 (2;2) ◽  
pp. E301-E308
Author(s):  
Kyung-Chul Choi
Keyword(s):  
Disc Herniation ◽  
Iliac Crest ◽  
Facet Joint ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Herniated Disc ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Endoscopic Lumbar Discectomy ◽  
Foraminal Height

Background: Percutaneous transforaminal techniques for the treatment of lumbar disc herniation have markedly evolved. Percutaneous endoscopic lumbar discectomy (PELD) for L5-S1 disc herniation is regarded as challenging due to the unique anatomy of the iliac crest, large facet joint, and inclinatory disc space. Among these, the iliac crest is considered a major obstacle. There are no studies regarding the height of the iliac crest and their appropriate procedures in PELD. Objectives: This study discusses PELD for L5-S1 disc herniation and the appropriate approach according to the height of iliac crest. Study Design: Retrospective evaluation. Methods: 100 consecutive patients underwent PELD via the transforaminal route for L5-S1 disc herniation by a single surgeon. The study was divided into 2 groups: the foraminoplasty group requiring foraminal widening to access the herniated disc and the non-foraminoplasty group treated by conventional posterolateral access. Radiological parameters such as iliac height, the relative position of the iliac crest to the landmarks of the L5-S1 level, iliosacral angle and foraminal height, and disc location were considered. Clinical outcomes were assessed by the Visual Analogue Scale (VAS, 0 – 10) for back and leg pain, the Oswestry Disability Index (ODI, 0 – 100%), and the modified MacNab criteria. Results: The overall VAS scores for back and leg pain decreased from 6.0 to 2.3 and from 7.5 to 1.7. The mean ODI (%) improved from 54.0 to 11.6. Using modified MacNab criteria, a good outcome was 92%. Foraminoplasty was required in 19 patients. Iliac crest height was significantly higher in the foraminoplasty group than the non-foraminoplasty group (37.7 mm vs 30.1 mm, P < 0.001). In the foraminoplasty group, the iliac crest is above the mid L5 pedicle on lateral radiography in all cases. There were no significant differences in foraminal height, foraminal width, iliosacral angle, or disc height between the 2 groups. In addition, there were no differences in clinical outcome between the 2 groups. Limitations: This study is a retrospective analysis and simplifies the complexity of the L5-S1 level and iliac bone using two-dimensional radiography. Conclusion: In high iliac crest cases where the iliac crest is above the mid L5 pedicle in lateral radiography, foraminoplasty may be considered for transforaminal access of L5-S1 disc herniation. Conventional transforaminal access can be utilized with ease in low iliac crest cases where the iliac crest is below the mid-L5 pedicle. Key words: Percutaneous endoscopic lumbar discectomy, transforaminal, L5-S1, iliac crest, foraminoplasty

scholarly journals Full Endoscopic Lumbar Discectomy Versus Laminectomy for Cauda Equina Syndrome

10.14444/8014 ◽  
2021 ◽  
Vol 15 (1) ◽  
pp. 105-112
Author(s):  
Liu Yankang ◽  
Zhang Leiming ◽  
Kai-Uwe Lewandrowski ◽  
Tang Xiangyu ◽  
Zhu Zexing ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Endoscopic Lumbar Discectomy

Percutaneous Endoscopic Lumbar Discectomy for Treating Cauda Equina Syndrome Due To Lumbar Disc Herniation

2021 ◽  
Author(s):  
Hai-Chao He ◽  
Xiao-qiang LV ◽  
Yong-Jin Zhang
Keyword(s):  
Back Pain ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Endoscopic Lumbar Discectomy

Abstract Background In recent decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, there is little literature on the use of percutaneous endoscopic lumbar discectomy (PELD) to treat cauda equina syndrome (CES) due to LDH. This study aims to evaluate the feasibility and clinical efficacy of PELD for treating CES caused by disc herniation, and as well as to report some technical strategies. Methods Between October 2012 and April 2018, 15 patients with CES caused by LDH at the early and intermediate stages of Shi’s classification were selected as the subjects of study, and underwent PELD. All patients were followed up for at least two years. The patients’ back pain and leg pain were evaluated using visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Patient satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively and at 3 days, 3 months, 6 months and the last follow-up. Results The VAS score for back pain, leg pain and ODI score significantly decreased from preoperatively scores of 6.67 ± 1.05, 7.13 ± 1.19 and 62.0 ± 6.85 respectively, to postoperatively cores of 1.80 ± 0.41, 1.47 ± 0.52 and 12.93 ± 1.03 at the last follow-up postoperatively. These postoperative scores were all significantly different compared with preoperative scores (P < 0.01). According to the modified MacNab outcome scale, 86.67% of these patients had excellent and good outcomes at the final follow-up. Complications included one patient with cerebrospinal fluid leakage and one patient who developed recurrent herniation; the latter patient finally achieved satisfactory results after reoperation. Conclusion PELD could be used as an alternative surgical method for the treatment of CES due to LDH in properly selected cases and appropriate patient selection. However, the operator should pay attention to foraminoplasty to enlarge the working space.

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