Operation Loupes and Headlight Were Used as Visual Aids during Cauda Equina Syndrome Operations

Cauda Equina Syndrome (CES) appeared as a postoperative complication in five patients that were operated on for lumbar disc herniation.

The study consisted of a retrospective analysis of records and radiographs in five patients who developed acute cauda equina syndrome after surgery for lumbar disc herniation.

The objective of the study was to postulate as a possible pathophysiologic mechanism the venous congestion caused by preexisting spinal stenosis and to present a management plan: extended decompression within 48 hours.

Cauda equina syndrome is reported as a sequela in 0.2%–1% of the surgeries for lumbar disc herniation. There is, however, no consensus on the possible pathophysiologic mechanism to the complication or to its management.

Methods uses for preoperative investigations consisted of magnetic resonance imaging, or myelography and computed tomography. There was a good correlation between clinical appearance and radiographic findings in all patients. When the complication became apparent in four of the patients, they were investigated with magnetic resonance imaging and reoperated on within 48 hours with wide decompressions.

During the operation, surgical loupes and headlights were used as visual aids. The index operation was reported uneventful in all patients. Postoperative magnetic resonance imaging did not show the cause of the cauda equina syndrome, nor could this be established at the reoperation.

Before surgery, all five patients had preexisting narrowing of the spinal canal. In no case was the lumbosacral disc the index level. Two patients recovered fully, whereas the other three experienced varying degrees of residual symptoms. There was no correlation between the end result and the delay until secondary decompression.

The researchers concluded that relative spinal stenosis may contribute to the development of cauda equina syndrome after surgery for lumbar disc herniation. A venous congestion can be triggered by postoperative edema, leading to nerve root ischemia. The treatment of choice seems to be extended decompression within 48 hours.

(Source: Henriques, Thomas MD*; Olerud, Claes MD, PhD*; Petrén-Mallmin, Marianne MD, PhD†; Ahl, Torbjörn MD, PhD Spine Journal Volume 26 – Issue 3 – pp 293-297)