Minimally Invasive Microscopic Lumbar Discectomy for Treatment of Cauda Equina Syndrome, Is It Effective?

Document Type : Original Articles


1 Neurosurgery Department, Ain Shams Univeristy

2 Neurological and Spine Surgery Department, Faculty of Medicine, October 6 University, Giza, Egypt.

3 Lecturer and Consultant of Neurosurgery, Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

4 Assistant Professor of Neurosurgery, Neurosurgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.


Background: This study aimed to assess the effectiveness of minimally invasive lumbar microscopic discectomy (MIS-LD) for treatment of huge or ruptured lumbar disc herniation (LDH) causing cauda equina syndrome (CES).
Methods: This is observational retrospective case series of 12 patients treated for CES due to huge/ruptured LDH with MIS-LD. Patient’s demographics and outcomes included: Visual Analogue Scale (VAS) and Medical Research Council (MRC) grading scale for low back pain (LBP), sciatica and lower limbs motor power assessment respectively. Oswestry Disability Index (ODI) for pain and weakness as functional score. Postoperative follow up for 18 months to evaluate recovery of sciatica, motor weakness, urinary/bowel functions, saddle area sensory changes and sexual dysfunction.
Results: All patients were males, aged 28–59 years with mean age ± standard deviation (SD) of 43.14±4.2 years. Operative time ranged from 90m–3h with mean time ± SD of 132.86±35m. Sciatica improved immediately, urinary and bowel functions recovered completely within weeks in all patients (100%). Lower extremity weakness improved after 1-3 months in 11 patients (92%). Sexual dysfunction improved from 8-10 weeks in all patients (100%). Finally, saddle area sensation returned to normal after six months in all affected patients (100%).
Conclusions: MIS-LD is effective and efficient procedure for treatment of CES caused by huge/ruptured LDH with approximately good recovery of motor power, full control of urinary, bowel and sexual functions, and normal saddle sensation without surgical side effects.