title: Percutaneous endoscopic lumbar discectomy for a huge herniated disc causing acute cauda equina syndrome: a case report.
abstract: Microsurgery for lumbar disc herniation that requires surgical intervention has been well described. The methods vary from traditional open discectomy to minimally invasive techniques. All need adequate preanesthetic preparation of patients as general anesthesia is required for the procedure, and nerve monitoring is necessary to prevent iatrogenic nerve injury. Conventional surgical techniques sometimes require the removal of the corresponding lamina to assess the nerve root and herniated disc, and this may increase the risk for posterior instability of the vertebral body. Should this occur, fusion surgery may be needed, further increasing morbidity and cost. We present here a case of lumbar herniated disc fragments causing acute cauda equina syndrome that were endoscopically resected through a transforaminal approach in an awake patient under local anesthesia. Percutaneous endoscopic discectomy under local anesthesia proved to be a better alternative to open back surgery as it made immediate intervention possible, was associated with fewer perioperative complications and morbidity, minimized soft tissue damage, and allowed early rehabilitation with a better outcome and greater patient satisfaction. In addition to these advantages, percutaneous endoscopic discectomy protects other approaches that may be needed in subsequent surgeries, whether open or minimally invasive.
authors: Department of Orthopedics, Tokushima University, Tokushima, Japan. 2. Department of Orthopedics and Traumatology, Kathmandu University Hospital, Dhulikhel, Nepal.
authors: Subash C
authors: SC
authors: Jha
authors: Ichiro
authors: I
authors: Tonogai
authors: Yoichiro
authors: Y
authors: Takata
authors: Toshinori
authors: T
authors: Sakai
authors: Kosaku
authors: K
authors: Higashino
authors: Tetsuya
authors: T
authors: Matsuura
authors: Naoto
authors: N
authors: Suzue
authors: Daisuke
authors: D
authors: Hamada
authors: Tomohiro
authors: T
authors: Goto
authors: Toshihiko
authors: T
authors: Nishisho
authors: Takahiko
authors: T
authors: Tsutsui
authors: Yuichiro
authors: Y
authors: Goda
authors: Mitsunobu
authors: M
authors: Abe
authors: Kazuaki
authors: K
authors: Mineta
authors: Tetsuya
authors: T
authors: Kimura
authors: Akihiro
authors: A
authors: Nitta
authors: Shingo
authors: S
authors: Hama
authors: Tadahiro
authors: T
authors: Higuchi
authors: Shoji
authors: S
authors: Fukuta
authors: Koichi
authors: K
authors: Sairyo
mesh_terms: D000328:Adult; D000772:Anesthesia, Local; D017587:Diskectomy, Percutaneous / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D011128:Polyradiculopathy / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*