Abstract

Background: To describe and evaluate a unilateral microscopic surgical approach for bilateral decompression and removal of massive lumbar disc herniations causing incomplete cauda equina syndrome, with the dual objective of rapid neurological recovery and minimization of postoperative segmental instability.
Methods: A retrospective review was conducted of all patients treated over the past eight years by the senior authors in whom this technique was employed to reverse presenting symptomatology and reduce the risk of postoperative instability.
Result: Fourteen patients presenting with massive lumbar disc herniation and incomplete cauda equina syndrome underwent surgery using the described approach. In all cases, bilateral neural decompression was achieved without technical difficulty, resulting in marked enlargement of the spinal canal and no radiographic evidence of postoperative instability. Neurological signs and symptoms improved immediately following surgery. At a minimum follow-up of one year in nine of the fourteen patients, no complaints suggestive of recurrent disc herniation or segmental instability were observed.
Conclusion: The unilateral microscopic approach employed by us for bilateral decompression and removal of massive lumbar disc herniations associated with incomplete cauda equina syndrome represents a safe, effective and stability-preserving alternative to more invasive decompression or fusion techniques currently in use.

Keywords: Unilateral microscopic approach; Bilateral lumbar discectomy; Massive lumbar disc herniation; Cauda equina syndrome