Cauda equina syndrome due to lumbar disc herniation managed with unilateral biportal endoscopic discectomy: A case report and review of literature.

Introduction and importance: Cauda equina syndrome is a rare spinal emergency due to compression of the cauda equina nerve roots which present with bladder and/or bowel dysfunction, saddle anesthesia, and sexual dysfunction with or without a neurological deficit in the lower limbs and requires urgent surgical decompression through open methods or new minimally invasive procedures like Unilateral Biportal Endoscopic Discectomy. Case presentation: A 38-year-old serving army personnel presented with history of urinary incontinence, constipation and paresthesia of left lower limb for 1 week, which was preceded by low backache for 2 months. Although the motor examination of L2-S1 nerves was intact, the perianal sensation was impaired with lax anal tone and absent bulbocavernosus reflex. After the confirmation of complete cauda equina syndrome clinically, supported by MRI of Lumbosacral spine with disc extrusion at L5-S1compressing on bilateral traversing S1 nerve roots as the cause, the patient underwent decompression surgery through unilateral biportal endoscopic method with almost complete recovery post-surgery. Clinical discussion: Cauda equina syndrome when diagnosed has been advised to undergo surgical decompression ideally within 48 h. The decompression can be done by open methods or minimally invasive methods. The minimally invasive endoscopic methods have been found to have better outcomes. Conclusion: Cauda equina syndrome, being an emergency with potentially devastating outcomes, require surgical decompression and presently minimally invasive techniques like Unilateral Biportal Endoscopy (UBE) are being popular due to decreased procedure related patient morbidity and quicker recovery.