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

Abstract

<jats:p>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.</jats:p>

Cauda Equina Syndrome: A Review of 15 Patients Who Underwent Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD) Under Local Anaesthesia

“…The recovery in CES may take months to years, as reported conventionally 3 , 31 . A three-case report of anterior lumbar surgery and another report of endoscope assisted OLIF (Oblique lumbar Interbody Fusion) in CES, report a dramatic quick recovery in bladder function 32 , 33 . Although these are relatively open surgery, this should raise a prudent question of an underestimated manipulative injury in posterior surgeries.…”

A Successful Outcome Despite Delayed Intervention for Cauda Equina Syndrome in a Young Patient with a Posterior Epidural Disc Extrusion

“…Finally, when considering surgical intervention for this specific pathology of the lumbar spine, Tan et al reported three successful cases of patients who suffered from CES who were successfully treated via the anterior approach with lumbar discectomy [17]. However, regardless of approach, early intervention for patients with complete or incomplete CES is necessary and associated with successful clinical outcomes with minimal neurological loss [18].…”