Endoscopic Spine Surgery in the Management of Cauda Equina Syndrome: A Systematic Review and Meta-Analysis.

Abstract

Systematic review and meta-analysis. This meta-analysis aims to systematically assess clinical and surgical outcomes of endoscopic spine surgery for cauda equina syndrome (CES). Endoscopic spine surgery has emerged as a minimally invasive alternative for CES treatment, yet its efficacy and safety remain uncertain. A systematic search of PubMed, Embase, and Web of Science was conducted in accordance with PRISMA guidelines. Continuous outcomes were analyzed as pooled means with 95% CIs, while dichotomous outcomes were pooled using a generalized linear mixed-effects model. Pooled estimates were calculated using random-effects models in R software (version 4.5.1). Seven studies (n=107) were included. The mean operative time was 55.6 minutes (95% CI: 42.0-73.5), with an estimated blood loss of 11.9 mL (95% CI: 1.2-118) and a hospital stay of 2.33 days (95% CI: 0.86-6.35). The overall complication rate was 7% (95% CI: 1.3-29.8) and the reoperation rate 4.5% (95% CI: 0.7-24.3). Postoperative outcomes demonstrated pooled mean reductions of -5.7 points in visual analog scale (VAS) Back (95% CI: -8.5 to -2.8), -7.7 points in VAS Leg (95% CI: -9.5 to -5.9), and a -57.7 percentage-point decrease in Oswestry Disability Index (95% CI: -74.0 to -41.4). Neurological recovery was also favorable, with pooled recovery rates of 78.3% for motor function (95% CI: 53.6-91.8), 67% for saddle anesthesia (95% CI: 34-89), and 97.8% for bladder/bowel function (95% CI: 15.8-100). Endoscopic spine surgery provides a safe and effective minimally invasive option for CES. Future prospective studies are warranted to further validate its long-term efficacy and safety.