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Lumbar microdiscectomy for cauda equina syndrome

Overview

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Learn the Lumbar microdiscectomy for cauda equina syndrome surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Lumbar microdiscectomy for cauda equina syndrome surgical procedure.

Lumbar disc prolapse is a common condition. Cauda equina syndrome is a rare complication of disc prolapse and occurs in around 1.8 per million people. It may present with back pain and/or sciatic pain, bladder or bowel dysfunction, perineal or saddle anaesthesia, and unilateral or bilateral lower limb radiculopathy.  It can affect patients of any age but is more common in patients with disc degeneration

It can be divided into CES with retention (CES-R) where there is painless urinary retention, or CES incomplete (CES-I) where there is alteration of normal bladder and bowel function. Both conditions should be investigated and treated as an emergency to prevent long-term sequelae and disability with persistent bladder and bowel dysfunction.  It is a different condition to those uncommon elderly patients who have critical spinal stenosis and may have intermittent perineal numbness which comes on at the same time as lower limb claudication symptoms and resolves with sitting.

There has been debate over the years of the critical time to surgery, with this varying from 6 hrs up to 48hrs.  The British Association of Spine Surgeons (BASS) and the Society of British Neurological Surgeons (SBNS) published recommendations in Dec 2018 which suggest operating at the earliest safe opportunity.  This depends on local expertise, the available resources, and the duration of symptoms.

This feature discusses the features of cauda equina syndrome and how to manage this.  It is an important aspect of spinal pathology to be familiar with if you are involved with any aspect of emergency care, spinal or orthopaedic patients.

 

Author:Mr Stephen Morris FRCS (Tr & Orth)

Institution: The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK

Surgical Steps

Welcome to the surgical steps quiz.

This tests your ability to recall the correct order in which the key steps of an operation should be performed.

There will be various legitimate variations in this order but the quiz doesn’t reflect this.
Your reference point for the steps quiz is just our operative technique.
It’s one starting point in helping you to learn the technique.

  • You simply “drag & drop” the boxes containing the descriptions of the steps into the order you think fits and submit for marking.
  • If you get it correct first time you will be presented your certificate at the end of the quiz.
  • If you need to do more work on the steps you access your marked version by clicking the“re-sit the quiz” button.
  • This will show the steps you ordered correctly highlighted in green and the incorrect ones in red.
  • The correct green steps are fixed and won’t move.
  • The red steps move differently after your initial attempt and swap locations with the step they are dragged and dropped onto .
  • Finally resubmit the quiz once again.
  • The quiz will let you keep going until you get all the steps in the right order.
  • The correct green steps are fixed and won’t move.
  • The red steps move differently after your initial attempt and swap locations with the step they are dragged and dropped onto .
  • Finally resubmit the quiz once again.
  • The quiz will let you keep going until you get all the steps in the right order.

COURSE PROGRESS

Surgical Steps

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