How to Confirm and Document Adequate Lumbar Spine Discectomy Intraoperatively?

Lumbar discectomy is a common procedure for acute disc prolapse, especially in patients with neurological deficit [1]. The literature describes using fluoroscopy intraoperatively to avoid wrong level and side [2]. However, there is no method to confirm/document adequate discectomy apart from a postoperative MRI. The authors' technique involves taking clinical photos of the removed disc material. This technique provides accurate, low-cost documentation, and the patient can review it post-operatively. This could be of significant value in large disc prolapse and cauda equina syndrome surgery.

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A Polyostotic Paget’s Disease Involving Lumbar Spine Presenting with Cauda Equina Syndrome: An Unusual Entity

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i10.2440 ◽

2021 ◽

Vol 11 (10) ◽

Author(s):

Shailesh Hadgaonkar ◽

Shaunak Patwardhan ◽

Pramod Bhilare ◽

Parag Sancheti ◽

Ashok Shyam

Keyword(s):

Lumbar Spine ◽

Neurological Deficit ◽

Cauda Equina Syndrome ◽

Indian Subcontinent ◽

Paget’S Disease ◽

Cauda Equina ◽

Neurological Complications ◽

Paget's Disease ◽

Metabolic Bone ◽

Cauda Equina Compression

Introduction:Paget’s disease of bone (PDB) is a metabolic bone disease presenting as polyostotic or monostotic lesions of the spine. Although common in the Anglo-Saxon population, it is rare on the Indian subcontinent. Neurological complications though infrequent can be severe in pagetic spine. Case Report:We report a case of a polyostotic variant of PDB involving lumbar spine (L2 vertebrae), iliac bones, and femur presenting as chronic low back pain and neurological deficit, i.e., cauda equina syndrome. On initial workup, a diagnosis of PDB was made and given cauda equina compression with neurological deficit, posterior spinal decompression, and biopsy was performed. The histopathological evaluation confirmed the diagnosis and the patient was treated with bisphosphonates for 6 months, along with serial monitoring of alkaline phosphatase levels. Conclusion:Through this case report, we hope to emphasize that PDB should be considered as a possible cause of neurological symptoms at presentation, especially in elderly patients. Also furthermore, early surgical intervention followed by bisphosphonates therapy can lead to favorable outcomes in such patients. Keywords:Polyostotic, Paget’s disease, cauda equine syndrome, lumbar spine.

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Anterior lumbar discectomy and fusion for acute cauda equina syndrome caused by recurrent disc prolapse: report of 3 cases

Journal of Neurosurgery Spine ◽

10.3171/2017.1.spine16352 ◽

2017 ◽

Vol 27 (4) ◽

pp. 352-356

Author(s):

Kimberly-Anne Tan ◽

Mathew D. Sewell ◽

Yma Markmann ◽

Andrew J. Clarke ◽

Oliver M. Stokes ◽

...

Keyword(s):

Disc Herniation ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Scar Tissue ◽

Lumbar Discectomy ◽

Neurological Injury ◽

Herniated Disc ◽

Disc Prolapse ◽

Recurrent Disc Herniation ◽

Previously Treated

There is a lack of information and consensus regarding the optimal treatment for recurrent disc herniation previously treated by posterior discectomy, and no reports have described an anterior approach for recurrent disc herniation causing cauda equina syndrome (CES). Revision posterior decompression, irrespective of the presence of CES, has been reported to be associated with significantly higher rates of dural tears, hematomas, and iatrogenic nerve root damage. The authors describe treatment and outcomes in 3 consecutive cases of patients who underwent anterior lumbar discectomy and fusion (ALDF) for CES caused by recurrent disc herniations that had been previously treated with posterior discectomy. All 3 patients were operated on within 12 hours of presentation and were treated with an anterior retroperitoneal lumbar approach. Follow-up ranged from 12 to 24 months. Complete retrieval of herniated disc material was achieved without encountering significant epidural scar tissue in all 3 cases. No perioperative infection or neurological injury occurred, and all 3 patients had neurological recovery with restoration of bladder and bowel function and improvement in back and leg pain. ALDF is one option to treat CES caused by recurrent lumbar disc prolapse previously treated with posterior discectomy. The main advantage is that it avoids dissection around epidural scar tissue, but the procedure is associated with other risks and further evaluation of its safety in larger series is required.

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