Spinal Endoscopy for Lumbar Disc Herniation Presenting With Cauda Equina Syndrome: A Systematic Review and Meta-analysis of the Literature

Objective: Published evidence on endoscopic treatment of lumbar disc herniation presenting with cauda equina syndrome (CES) remains limited. We therefore conducted a systematic review and meta-analysis to assess the effectiveness and safety of endoscopic techniques for CES secondary to lumbar disc herniation.Methods: Multiple databases were comprehensively searched for studies of patients with CES who underwent endoscopic lumbar discectomy. Eligible procedures were unilateral biportal endoscopy and uniportal full-endoscopic surgery. The primary outcomes were postoperative clinical improvement and the incidence of adverse events: nerve injury, dural tears, postoperative tethering, incomplete decompression, and revision surgery. Pooled analyses estimated the overall patient improvement rate and the overall and complication-specific incidence rates.Results: The search strategy and eligibility criteria yielded 17 studies comprising 153 patients for this systematic review and meta-analysis. After endoscopic surgery, the clinical improvement rate was 90.1% (95% confidence interval [CI], 83.0%–95.7%). The pooled complication rate was 3.1% (95% CI, 0.1%–8.2%), and the reoperation rate was 3.7% (95% CI, 0.2%–9.6%). For individual adverse events, the pooled recurrence rate was 4.5% (95% CI, 0.7%–10.1%), and nerve injury was reported in 2.6% of patients.Conclusion: Endoscopic lumbar discectomy for disc herniation causing CES was associated with high clinical improvement rates and low reported complication rates. However, these findings are based on observational evidence and warrant caution: the limited quantity and quality of the available data preclude definitive claims of equivalence to open surgery.