RESUMEN
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.
RESUMEN
BACKGROUND: Uniportal interlaminar contralateral endoscopic lumbar foraminotomy (ICELF) aims to achieve decompression of lumbar spinal stenosis in the contralateral lateral recess and foraminal and extraforaminal regions of the same segment. This technique is performed under normal saline irrigation using an endoscope with optical lens magnification close to the targeted stenotic segment and has the potential of lower incidence of exiting nerve root dorsal root ganglion irritation. METHODS: A systematic review of the ICELF technique was conducted from March 2000 to March 2022. Articles were selected with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eligibility of studies was independently determined by 2 reviewers, and disagreements were resolved by a third author. RESULTS: Eight retrospective cohort studies comprising 194 patients with foraminal stenosis who underwent uniportal ICELF were selected for systematic review. Mean age range was 62-79 years, and surgical duration was 48-73.5 minutes. There was significant improvement in Oswestry Disability Index and visual analog scale leg pain score in the included studies. Four studies met the minimum clinically significant difference for leg pain, with visual analog scale improved >5 points and Oswestry Disability Index improved >8.2 points. Four studies reported a majority of the operated patients with good or excellent outcomes following surgery, with a low rate of complications in the studies selected. CONCLUSIONS: There is low-level evidence that ICELF when performed by an experienced spinal endoscopic surgeon is effective in providing pain relief and improved function with low rate of complications in select patients.