Biportal endoscopic lumbar discectomy surgery in patients with cauda equina syndrome caused by lumbar herniated intervertebral disc: a retrospective multi-center cohort study.

Abstract

Cauda equina syndrome (CES) is a severe neurological condition caused by significant compression of the cauda equina nerve roots. This study evaluates the efficacy of biportal endoscopic (BE) lumbar discectomy in treating CES caused by lumbar herniated intervertebral discs. This retrospective case series includes 32 CES patients treated with BE lumbar discectomy from March 2017 to July 2022. Patient demographics, surgical details, and outcomes were analyzed. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and EQ-5D scores at baseline, and at 3, 6, and 12 months postoperatively. The mean age was 44.44 ± 13.70 years. The average duration from symptom onset to surgery was 44.81 ± 32.69 h. Significant improvements at 12 months were observed in VAS for back pain (5.00 ± 2.82 to 1.28 ± 1.63, p < 0.01) and leg pain (7.44 ± 1.79 to 1.16 ± 1.55, p < 0.01), ODI (58.25 ± 20.15 to 10.13 ± 14.54, p < 0.01), and EQ-5D (0.414 ± 0.175 to 0.859 ± 0.163, p < 0.01). Bladder and bowel symptom recovery rates were 86.7% and 85.0%, respectively. Mean operation time was 42.50 ± 17.91 min, with a hospital stay of 3.34 ± 2.59 days. Complications included incidental durotomy (6.3%) and facet joint injury (6.3%). Biportal endoscopic spine surgery is a feasible and effective option for CES, providing significant decompression with minimal tissue damage and a low complication rate.