Technical feasibility of combined uniportal unilateral laminotomy with bilateral decompression and interlaminar lumbar discectomy surgery for cauda equina syndrome due to lower lumbar disc herniation
Background: Traditionally, open wide laminectomy and discectomy have been advocated for the treatment of cauda equina syndrome caused by lumbar disc herniation. We aimed to evaluate the technical feasibility of uniportal interlaminar endoscopy in treating cauda equina syndrome. Methods: Nine patient...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | North American Spine Society Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666548423000926 |
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| author | Wu Pang Hung, MBBS, MRCS, GDFM, MMED, FRCS Rohit Akshay Kavishwar, MBBS, MS, DNB, FNB Hyeun Sung Kim, MD, PhD Brian Zhao Jie Chin, BMed, MD |
| author_facet | Wu Pang Hung, MBBS, MRCS, GDFM, MMED, FRCS Rohit Akshay Kavishwar, MBBS, MS, DNB, FNB Hyeun Sung Kim, MD, PhD Brian Zhao Jie Chin, BMed, MD |
| author_sort | Wu Pang Hung, MBBS, MRCS, GDFM, MMED, FRCS |
| collection | DOAJ |
| description | Background: Traditionally, open wide laminectomy and discectomy have been advocated for the treatment of cauda equina syndrome caused by lumbar disc herniation. We aimed to evaluate the technical feasibility of uniportal interlaminar endoscopy in treating cauda equina syndrome. Methods: Nine patients with cauda equina syndrome underwent uniportal endoscopic decompression and discectomy from December 2020 to December 2022. Data were collected retrospectively. Patients diagnosed with cauda equina syndrome were operated on within 6 hours of presentation to the hospital. The visual analogue score (VAS), Oswestry disability index (ODI), and bladder/bowel score were used to measure the outcome. Results: Analysis showed that VAS scores for leg pain and back pain significantly decreased from preoperative scores of 8.22±0.79 and 4.67±1.76 to postoperative day 1 scores of 0.67±0.67 and 2.56±1.42 (p<.05). The ODI scores improved from preoperative 52.33±11.93 to postoperative (day 1) 14±6.80. Eight patients had early recovery (1 week) of bladder and bowel functions, and one had delayed recovery at 8 months. None of the patients had a residual bowel/bladder deficit. Macnab's criteria outcomes were excellent in all patients at the final follow-up. Conclusions: Uniportal endoscopic lumbar endoscopic unilateral laminotomy with bilateral decompression and subsequent interlaminar endoscopic lumbar discectomy is a safe and effective minimally invasive course of treatment for cauda equina syndrome as an alternative to open laminectomy in our cohort of patients. |
| first_indexed | 2024-03-08T23:10:36Z |
| format | Article |
| id | doaj.art-9baec871cefa44b495d2609004af2c9f |
| institution | Directory Open Access Journal |
| issn | 2666-5484 |
| language | English |
| last_indexed | 2024-03-08T23:10:36Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | North American Spine Society Journal |
| spelling | doaj.art-9baec871cefa44b495d2609004af2c9f2023-12-15T07:26:31ZengElsevierNorth American Spine Society Journal2666-54842023-12-0116100290Technical feasibility of combined uniportal unilateral laminotomy with bilateral decompression and interlaminar lumbar discectomy surgery for cauda equina syndrome due to lower lumbar disc herniationWu Pang Hung, MBBS, MRCS, GDFM, MMED, FRCS0Rohit Akshay Kavishwar, MBBS, MS, DNB, FNB1Hyeun Sung Kim, MD, PhD2Brian Zhao Jie Chin, BMed, MD3Division of Spine Sugery Orthopaedic Surgery, Jurong Health Campus, National University Health System, 1 Jurong East St 21, 609606, SingaporeSpine Division Orthopaedic Surgery Jurong Health Campus, National University Health System, 1 Jurong East St 21, 609606, Singapore; Corresponding author. Spine Division Orthopaedic Surgery Jurong Health Campus, National University Health System, 1 Jurong East St 21, 609606, Singapore. Tel.: +91-9426-9440.Department of Neurosurgery, Nanoori Hospital Gangnam, 731, Eonju-ro, Gangnam-gu, Seoul, Republic of KoreaOrthopaedic Surgery Resident, National University Hospital Singapore, SingaporeBackground: Traditionally, open wide laminectomy and discectomy have been advocated for the treatment of cauda equina syndrome caused by lumbar disc herniation. We aimed to evaluate the technical feasibility of uniportal interlaminar endoscopy in treating cauda equina syndrome. Methods: Nine patients with cauda equina syndrome underwent uniportal endoscopic decompression and discectomy from December 2020 to December 2022. Data were collected retrospectively. Patients diagnosed with cauda equina syndrome were operated on within 6 hours of presentation to the hospital. The visual analogue score (VAS), Oswestry disability index (ODI), and bladder/bowel score were used to measure the outcome. Results: Analysis showed that VAS scores for leg pain and back pain significantly decreased from preoperative scores of 8.22±0.79 and 4.67±1.76 to postoperative day 1 scores of 0.67±0.67 and 2.56±1.42 (p<.05). The ODI scores improved from preoperative 52.33±11.93 to postoperative (day 1) 14±6.80. Eight patients had early recovery (1 week) of bladder and bowel functions, and one had delayed recovery at 8 months. None of the patients had a residual bowel/bladder deficit. Macnab's criteria outcomes were excellent in all patients at the final follow-up. Conclusions: Uniportal endoscopic lumbar endoscopic unilateral laminotomy with bilateral decompression and subsequent interlaminar endoscopic lumbar discectomy is a safe and effective minimally invasive course of treatment for cauda equina syndrome as an alternative to open laminectomy in our cohort of patients.http://www.sciencedirect.com/science/article/pii/S2666548423000926Cauda equina syndromeUniportal endoscopyEndoscopic spine surgeryInterlaminar endoscopySpinal stenosis |
| spellingShingle | Wu Pang Hung, MBBS, MRCS, GDFM, MMED, FRCS Rohit Akshay Kavishwar, MBBS, MS, DNB, FNB Hyeun Sung Kim, MD, PhD Brian Zhao Jie Chin, BMed, MD Technical feasibility of combined uniportal unilateral laminotomy with bilateral decompression and interlaminar lumbar discectomy surgery for cauda equina syndrome due to lower lumbar disc herniation North American Spine Society Journal Cauda equina syndrome Uniportal endoscopy Endoscopic spine surgery Interlaminar endoscopy Spinal stenosis |
| title | Technical feasibility of combined uniportal unilateral laminotomy with bilateral decompression and interlaminar lumbar discectomy surgery for cauda equina syndrome due to lower lumbar disc herniation |
| title_full | Technical feasibility of combined uniportal unilateral laminotomy with bilateral decompression and interlaminar lumbar discectomy surgery for cauda equina syndrome due to lower lumbar disc herniation |
| title_fullStr | Technical feasibility of combined uniportal unilateral laminotomy with bilateral decompression and interlaminar lumbar discectomy surgery for cauda equina syndrome due to lower lumbar disc herniation |
| title_full_unstemmed | Technical feasibility of combined uniportal unilateral laminotomy with bilateral decompression and interlaminar lumbar discectomy surgery for cauda equina syndrome due to lower lumbar disc herniation |
| title_short | Technical feasibility of combined uniportal unilateral laminotomy with bilateral decompression and interlaminar lumbar discectomy surgery for cauda equina syndrome due to lower lumbar disc herniation |
| title_sort | technical feasibility of combined uniportal unilateral laminotomy with bilateral decompression and interlaminar lumbar discectomy surgery for cauda equina syndrome due to lower lumbar disc herniation |
| topic | Cauda equina syndrome Uniportal endoscopy Endoscopic spine surgery Interlaminar endoscopy Spinal stenosis |
| url | http://www.sciencedirect.com/science/article/pii/S2666548423000926 |
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