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

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.

scholarly journals How to Confirm and Document Adequate Lumbar Spine Discectomy Intraoperatively?

2020 ◽  
pp. 1-2
Author(s):  
Joseph Gamal Boktor ◽  
Joseph Gamal Boktor ◽  
Miriam Nakanda Kakaire ◽  
Ashish Khurana ◽  
Devi Prakash Tokala
Keyword(s):  
Lumbar Spine ◽  
Neurological Deficit ◽  
Cauda Equina Syndrome ◽  
Low Cost ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Disc Prolapse ◽  
Common Procedure ◽  
Postoperative Mri ◽  
Disc Material

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.

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.

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 Recurrent disc herniation following percutaneous endoscopic lumbar discectomy preferentially occurs when Modic changes are present

2019 ◽  
Author(s):  
Lu Hao ◽  
Shengwen Li ◽  
Junhui Liu ◽  
Zhi Shan ◽  
Shunwu Fan ◽  
...  
Keyword(s):  
Nucleus Pulposus ◽  
Disc Herniation ◽  
Hyaline Cartilage ◽  
Modic Changes ◽  
Lumbar Discectomy ◽  
Herniated Disc ◽  
Type I ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Recurrent Disc Herniation ◽  
Endoscopic Lumbar Discectomy

Abstract Objective: To investigate the effect of Modic changes (MCs) and the herniated disc component on recurrent lumbar disc herniation (rLDH) following percutaneous endoscopic lumbar discectomy (PELD).Methods: We included 102 (65 males,37 females, aged 20–66 yr) inpatients who underwent PELD from August 2013 to August 2016. All patients underwent CT and MRI preoperative. The presence and type of Modic changes were assessed. During surgery the herniated disc component of each patient was classified into two groups: Nucleus pulposus group, Hyaline cartilage group. The association of herniated disc component with Modic changes was investigated. The incidence of recurrent disc herniation was assessed on more than 2-year follow-up.Results: In total, 11 patients were lost to follow up; the other 91 were followed up for 24–60 months. Of the 91 patients, 99 discs underwent PELD; 28/99 (28.3%) had MCs. Type I and II MCs were seen in 9 (9.1%) and 19 (19.2%), respectively; no type III MCs were found. Among 28 endplates with MCs, according to the herniated disc component, 18/28 (64.3%) showed evidence of hyaline cartilage in the intraoperative specimens, including 6/9 and 12/19 endplates with type I and II MCs, respectively. Among 71 endplates without MCs, 14/71 (19.7%) showed evidence of hyaline cartilage in the intraoperative specimens. Hyaline cartilage was more common in patients with MCs (P<0.05). We found 2 cases of rLDH in the non-MC group (n=71); 6 cases rLDH were found in the MC group (n=28), including 2 and 4 cases for types I and II, respectively. There was no significant difference between types I and II (P>0.05). rLDH was more common in patients with MCs (P<0.05). We found 5 rLDH cases in the hyaline cartilage group (n=32); 3 rLDH cases were found in the nucleus pulposus group (n=67). rLDH was more common in the hyaline cartilage group (P<0.05). Conclusions: MCs were associated with the herniated cartilage disc component. rLDH following PELD preferentially occurs when MCs or the herniated cartilage are present.

Diagnostic Value of Computed Tomography in Recurrent Pain after Discectomy

Neurosurgery ◽  
1987 ◽  
Vol 20 (2) ◽  
pp. 302-309 ◽  
Author(s):  
Gerald R. Schell ◽  
Luciano M. Modesti ◽  
Edwin D. Cacayorin
Keyword(s):  
Computed Tomography ◽  
Disc Herniation ◽  
Scar Tissue ◽  
Diagnostic Value ◽  
Herniated Disc ◽  
Recurrent Pain ◽  
Clinical Criteria ◽  
Recurrent Disc Herniation ◽  
Contrast Enhanced Ct ◽  
Enhanced Ct

Abstract Intravenously enhanced computed tomography (CT) was used in patients in whom the differential diagnosis between recurrent herniated disc and postoperative scar was considered. Enhanced CT images demonstrated postoperative herniated discs more accurately than clinical criteria, myelography, or plain or postmetrizamide CT. The scar tissue shows contrast enhancement, but recurrent disc herniation does not. Therefore, contrast-enhanced CT is considered to be a valuable aid in distinguishing between recurrent disc herniation and hypertropic scar formation.

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 Treatment of cauda equina syndrome due to lumbar disc herniation with percutaneous endoscopic lumbar discectomy

2020 ◽  
Author(s):  
Hai-Chao He ◽  
Yong-jin Zhang
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Lumbar Pain ◽  
Limb Pain ◽  
Endoscopic Lumbar Discectomy

Abstract Background: Throughout the last decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, there is little literature on the treatment of Cauda Equina Syndrome (CES) due to lumbar disc herniation with percutaneous endoscopic lumbar discectomy (PELD). This study aims to evaluate the feasibility and clinical efficacy of PELD for CES caused by disc herniation.Methods: Between October 2012 and April 2017, 15 patients CES caused by LDH at the early and intermediate stages of Shi’s classification were selected as the objects of study, who underwent PELD. All patients were followed up for at least two years. The patients’ lumbar pain and limb pain were evaluated using visual analogue scale (VAS) scores. Patient's satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively, at 3 days, 3 months, 6 month and the last follow-up.Results: The VAS score for lumbar pain was 6.67±1.05 preoperatively and 3.27±0.96, 2.73±0.46, 2.40±0.51, and 1.80±0.41, at 3 days, 3 months, 6 months and the last follow-up postoperatively respectively. The VAS score for limb pain was 7.13±1.19 preoperatively and 2.93±0.80, 2.60±0.51, 2.20±0.56, and 1.47±0.52, at 3 days, 3 months, 6 months and the last follow-up postoperatively respectively. These postoperative scores were all significantly different when compared with preoperative scores (P < 0.01). According to the modified MacNab outcome scale, excellent was obtained in 8 of 15 patients, good was obtained in 5 patients, and fair was obtained in 2 patients, and 86.67% of these patients had excellent and good outcomes at the final follow-up. Complications included one patient of cerebrospinal fluid leakage, and one patient developed recurrent herniation and who finally acquired satisfactory result after reoperation.Conclusion: PELD could be used as an alternative surgical method for the treatment of CES due to lumbar disc herniation 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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