Comparison of capsule and posterior lumbar interbody fusion in cauda equina syndrome with retention: a 24-month follow-up study

• Published in: European journal of medical research Vol. 29; no. 1; pp. 493 - 13
• Main Authors: Li, Fudong, Ji, Chenglong, Han, Linhui, Sun, Jingchuan, Sun, Kaiqiang, Shi, Jiangang, Zhang, Bin
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.10.2024; BioMed Central; BMC
• Subjects: Adult; Aged; Capsule lumbar interbody fusion (CLIF); Care and treatment; Cauda Equina Syndrome - surgery; Cauda equina syndrome with retention (CESR); Comparative analysis; Female; Follow-Up Studies; Humans; Intervertebral Disc Displacement - complications; Intervertebral Disc Displacement - surgery; Lumbar Vertebrae - surgery; Male; Medical research; Medicine, Experimental; Middle Aged; Nerve tension; Pain; Posterior lumbar interbody fusion (PLIF); Retrospective Studies; Spinal Fusion - adverse effects; Spinal Fusion - methods; Treatment Outcome; Urinary incontinence; Urinary Retention - etiology; Urinary Retention - surgery; Cauda equina syndrome with retention (CESR); Capsule lumbar interbody fusion (CLIF); Nerve tension; Posterior lumbar interbody fusion (PLIF)
• ISSN: 2047-783X; 0949-2321; 2047-783X
• DOI: 10.1186/s40001-024-02067-0

Cauda equina syndrome with retention (CESR) is a severe lumbar condition characterized by painless urine retention due to cauda equina nerve injury. The standard treatment, posterior lumbar interbody fusion (PLIF), often yields suboptimal results. This study aims to compare the clinical safety and efficacy of a novel technique, capsule lumbar interbody fusion (CLIF), with PLIF in CESR patients, hypothesizing that CLIF can enhance neurological recovery by reducing nerve tension. A single-center, retrospective study was conducted on 83 patients with CESR due to lumbar disc herniation, who underwent either PLIF (n = 44) or CLIF (n = 39). Patients were assessed preoperatively and at 3, 12, and 24 months postoperatively using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF), and Rintala score. Urodynamic studies and nerve tension measurements were also performed. Statistical analysis included t tests, Mann-Whitney U tests, and Spearman's correlation. Both groups showed significant postoperative improvements, but the CLIF group had superior outcomes. At 12 months, the CLIF group had lower VAS scores (1.15 ± 0.84 vs. 1.68 ± 0.60, p = 0.001) and ODI scores (23.31 ± 7.51 vs. 28.30 ± 8.26, p = 0.005). At 24 months, the CLIF group continued to show better results with ODI scores (15.97 ± 6.43 vs. 22.11 ± 6.41, p < 0.001) and higher ODI recovery rates (60.41 ± 17.6% vs. 44.71 ± 18.99%, p < 0.001). The CLIF group also had better ICI-Q-SF scores (2.13 ± 1.23 vs. 3.02 ± 1.45, p = 0.004) and Rintala scores (17.97 ± 1.43 vs. 16.59 ± 1.54, p < 0.001). Lower postoperative nerve tension in the CLIF group correlated with these improved outcomes. CLIF demonstrated superior efficacy over PLIF in treating CESR, with significant improvements in pain relief, functional recovery, and bladder and bowel function. This study highlights the potential of CLIF as a more effective surgical option for CESR, emphasizing its importance in improving patient outcomes and reducing the burden of CESR on patients and society.