Spinal Hernia Repair and Cauda Equina Repositioning after Lumbar Decompression under Three-Dimensional Microscopy: A Case Report and Literature Review

Cauda equina herniation (CEH) is a relatively rare and severe perioperative complication that may occur after lumbar spine surgery. Here, we present a case report of a 36-year-old female patient who experienced CEH after an endoscopic L5-S1 laminectomy and discectomy. The patient presented with right L5-S1 radiculopathy that correlated with findings in medical imaging and physical examination. Subsequently, she underwent endoscopic L5-S1 laminotomy and discectomy. A day after the operation, the patient developed urine leakage, hematochezia, aggravated constipation, and found no relief from pain in the right lower limb. MRI revealed cerebrospinal fluid leakage at the surgical site. After consultation with the urology and anorectal department, the patient was fitted with a urinary catheter, prescribed hemorrhoid medication, and underwent anal sphincter training as recommended by the doctor. After 1 week of treatment, the patient's urinary function returned to normal, but constipation persisted while the pain in the right lower limb eased. After 5 months, the patient was hospitalized due to radiating pain in both lower limbs and constipation. An MRI revealed herniation of the L5/S1 nerve root sac. Subsequently, L5/S1 total laminectomy decompression and dural sac repair were performed under a three-dimensional (3D) microscopy. Postoperatively, lower limb pain and constipation were alleviated. CEH following spinal endoscopy, though rare, demands significant clinical attention. The successful outcome in this case illustrates the value of surgical revision under 3D microscopic guidance, offering a viable strategy for patients presenting with this complication.