MOJ Header

Current Issue - July 2020, Volume 14, Issue No. 2

Official Journal of Malaysian Orthopaedic Association and ASEAN Orthopaedic Association

Cauda Equina Syndrome: A Review of 15 Patients Who Underwent Percutaneous Transforaminal Endoscopic Lumbar Discectomy (PTELD) Under Local Anaesthesia


  1. Gitelman A, Hishmeh S, Morelli BN, Joseph SA, Casden A, Kuflik P, et al. Cauda equina syndrome: a comprehensive review. Am J Orthop (Belle Mead NJ). 2008; 37(11): 556-62.
  2. Kapetanakis S, Chaniotakis C, Kazakos C, Papathanasiou JV. Cauda equina syndrome due to lumbar disc herniation: a review of literature. Folia Med (Plovdiv). 2017; 59(4): 377-86. doi: 10.1515/folmed-2017-0038
  3. Gardner A, Gardner E, Morley T. Cauda equina syndrome: a review of the current clinical and medico-legal position. Eur Spine J. 2011; 20(5): 690-7. doi: 10.1007/s00586-010-1668-3
  4. Fraser S, Roberts L, Murphy E. Cauda equina syndrome: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil. 2009; 90(11): 1964-8. doi: 10.1016/j.apmr.2009.03.021
  5. Olivero WC, Wang H, Hanigan WC, Henderson JP, Tracey PT, Elwood PW, et al. Cauda equina syndrome (CES) from lumbar disc herniations. J Spinal Discord Tech. 2009; 22(3): 202-6. doi: 10.1097/BSD.0b013e31817baad8
  6. Dave BR, Samal P, Sangvi R, Degulmadi D, Patel D, Krishnan A. Does the Surgical Timing and Decompression Alone or Fusion Surgery in Lumbar Stenosis Influence Outcome in Cauda Equina Syndrome?. Asian Spine J. 2019; 13(2): 198-209. doi: 10.31616/asj.2018.0168
  7. Kim HS, Kim SW, Lee SM, Shin H. Endoscopic discectomy for the cauda equina syndrome during third trimester of pregnancy. J Korean Neurosurg Soc. 2007; 42(5): 419-20. doi: 10.3340/jkns.2007.42.5.419
  8. Kim HS, Adsul N, Ju YS, Kim KJ, Choi SH, Kim JH, et al. Percutaneous Endoscopic Transforaminal Lumbar Discectomy for Massive Disc Herniation Causing Cauda Equina Syndrome: A Case Report. J Minim Invasive Spine Surg Tech. 2018; 3(1): 27-9. doi:
  9. Jha SC, Tonogai I, Takata Y, Sakai T, Higashino K, Matsuura T, et al. Percutaneous endoscopic lumbar discectomy for a huge herniated disc causing acute cauda equina syndrome: A case report. J Med Invest. 2015; 62(1-2): 100-2. doi: 10.2152/jmi.62.100
  10. Li X, Dou Q, Hu S, Liu J, Kong Q, Zeng J, et al. Treatment of cauda equina syndrome caused by lumbar disc herniation with percutaneous endoscopic lumbar discectomy. Acta Neurol Belg. 2016; 116(2):185-90. doi: 10.1007/s13760-015-0530-0
  11. Namboothiri S, Gore S, Raja P. Novel Surgical Technique for discogenic cauda equina syndrome-transforaminal intra discal access by annulotomy outside central spinal canal. J Spine. 2016; S7. doi: 10.4172/2165-7939.S7-008
  12. Mahesha K. Percutaneous endoscopic lumbar discectomy: Results of first 100 cases. Indian J Orthop. 2017; 51(1): 36-42. doi: 10.4103/0019-5413.197520
  13. Gu YT, Cui Z, Shao HW, Ye Y, Gu AQ. Percutaneous transforaminal endoscopic surgery (PTES) for symptomatic lumbar disc herniation: a surgical technique, outcome, and complications in 209 consecutive cases. J Orthop Surg Res. 2017;12(1):25. doi: 10.1186/s13018-017-0524-0
  14. Gore S, Yeung A. The “inside out” transforaminal technique to treat lumbar spinal pain in an awake and aware patient under local anesthesia: results and a review of the literature. Int J Spine Surg. 2014; 8: 28. doi: 10.14444/1028
  15. Lewandrowsk KU. “Outside-in" technique, clinical results, and indications with transforaminal lumbar endoscopic surgery: a retrospective study on 220 patients on applied radiographic classification of foraminal spinal stenosis. Int J Spine Surg. 2014; 8: 26. doi: 10.14444/1026
  16. Ruetten S, Komp M, Godolias G. An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine (Phila Pa 1976). 2005; 30(22): 2570-8. doi: 10.1097/
  17. Tan M, Law LSC, Gan TJ. Optimizing pain management to facilitate enhanced recovery after surgery pathways. Can J Anaesth. 2015; 62(2): 203-18. doi: 10.1007/s12630-014-0275-x
  18. Venkatesan M, Nasto L, Grevitt MP, Tsegaye MM. Is post-void bladder scan a useful adjunct to the clinical examination for prediction of cauda equine syndrome?. Spine J. 2017; 17(3): S7.
  19. Cappelleri JC, Rosen RC. The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. IntJ Impot Res. 2005; 17(4): 307-19. doi: 10.1038/sj.ijir.3901327
  20. Mixter WJ, Barr JS. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med. 1934; 211: 210-5. doi: 10.1056/NEJM193408022110506
  21. Fuso FAF, Dias ALN, Letaif OB, Cristante AF, Marcon RM, de Barros TEP. Epidemiological study of cauda equina syndrome. Acta Ortop Bras. 2013; 21(3): 159-62. doi: 10.1590/S1413-78522013000300006
  22. Srikandarajah N, Wilby M, Clark S, Noble A, Williamson P, Marson T. Outcomes reported after surgery for cauda equina syndrome: a systematic literature review. Spine (Phila Pa 1976). 2018; 43(17): E1005-13. doi: 10.1097/BRS.0000000000002605
  23. Gleave JRW, Macfarlane R. Cauda equina syndrome: what is the relationship between timing of surgery and outcome?. Br J Neurosurg. 2002; 16(4): 325-8. doi: 10.1080/0268869021000032887
  24. Tullberg T, Isacson J. Cauda equina syndrome with normal lumbar myelography. Acta Orthop Scand. 1989; 60(3): 265-7. doi: 10.3109/17453678909149274
  25. Bischoff RJ, Rodriguez RP, Gupta K, Righi A, Dalton JE, Whitecloud TS. A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis. J Spinal Disord. 1993; 6(4): 289-95. doi: 10.1097/00002517-199306040-00002
  26. Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine (Phila Pa 1976). 2000; 25(12): 1515-22. doi: 10.1097/00007632-200006150-00010
  27. Fehlings MG, Zeidman SM, Jha N, Rampersaud YR. Spine surgery -techniques, complication avoidance and management. In: Benzel EC, editor. Cauda equina syndrome. 3rd ed. Philadelphia: Elsevier/Saunders; 2012.
  28. Podnar S. Cauda equina lesions as a complication of spinal surgery. Eur Spine J. 2010; 19(3): 451-7. doi: 10.1007/s00586-009-1170-y
  29. Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976). 2002; 27(7): 722-31. doi: 10.1097/00007632-200204010-00009
  30. Ruetten S, Komp M, Godolias G. Lumbar discectomy with the full- endoscopic interlaminar approach using new-developed optical systems and instruments. WSJ. 2006; 1(3):148-56.
  31. Hellstrom P, Kortelainen P, Kontturi M. Late urodynamic findings after surgery for cauda equina syndrome caused by a prolapsed lumbar intervertebral disk. J Urol. 1986;135(2): 308-12. doi: 10.1016/s0022-5347(17)45621-7
  32. Tan KA, Sewell MD, Markmann Y, Clarke AJ, Stokes OM, Chan D. Anterior lumbar discectomy and fusion for acute cauda equina syndrome caused by recurrent disc prolapse: report of 3 cases. J Neurosurg Spine. 2017; 27(4): 352-6. doi: 10.3171/2017.1.SPINE16352
  33. Kim JS, Seong JH. Endoscope-assisted oblique lumbar interbody fusion for the treatment of cauda equina syndrome: a technical note. Eur Spine J. 2017;26(2): 397-403. doi: 10.1007/s00586-016-4902-9
  34. Aiyer SN, Kumar A, Shetty AP, Kanna RM, Rajasekaran S. Factors influencing postoperative urinary retention following elective posterior lumbar spine surgery: a prospective study. Asian Spine J. 2018; 12(6): 1100-5. doi: 10.31616/asj.2018.12.6.1100
  35. Webb J, Gottschalk IV L, Lee YP, Garfin S, Kim C. Surgeon perceptions of minimally invasive spine surgery. SAS J. 2008; 2(3): 145-9. doi: 10.1016/S1935-9810(08)70032-X
  36. Choi KC, Lee JH, Kim JS, Sabal LA, Lee S, Kim H, et al. Unsuccessful percutaneous endoscopic lumbar discectomy: a singlecenter experience of 10,228 cases. Neurosurgery. 2015; 76(4): 372–380. doi: 10.1227/NEU.0000000000000628
  37. Ahn Y, Lee HY, Lee SH, Lee JH. Dural tears in percutaneous endoscopic lumbar discectomy. Eur Spine J. 2011; 20(1): 58-64. doi: 10.1007/s00586-010-1493-8
  38. Rajasekaran S, Bajaj N, Tubaki V, Kanna RM, Shetty AP. Anatomy of Failure in Lumbar Disc Herniation. An in Vivo, Multimodal, Prospective Study of 181 Subjects. Global Spine J. 2014; 4(1_suppl). doi: 10.1055/s-0034-1376749
  39. Podnar S, Trsinar B, Vodusek DB. Bladder dysfunction in patients with cauda equina lesions. Neurourol Urodyn. 2006; 25(1): 23-31. doi: 10.1002/nau.20188

Abstract   |   Reference

MOJ footer

About Us

The Malaysian Orthopaedic Journal is a peer-reviewed journal that is published three times a year in both print and electronic online version. The purpose of this journal is to publish original research studies, evaluation of current practices and case reports in various subspecialties of orthopaedics and traumatology, as well as associated fields like basic science, biomedical engineering, rehabilitation medicine and nursing.

Keep in Touch

creative-commons License