Study design: A retrospective clinical review.Purpose: To explore the type, morbidity, risk factors and treatment strategies of postoperative complication following percutaneous endoscopic lumbar discectomy (PELD) surgery.Overview of literature: PELD became one of the main operation methods for degenerative lumbar diseases, including disc herniation, stenosis and discogenic low back pain. However, complications following PELD surgery are a considerable challenge for spinal surgeons and seldom addressed publicly.Methods: 10120 patients after PELD surgery were studied. These surgeries were finished by 6 surgeons from 3 main minimal invasive spine centers from January 2012 to June 2017. Most of patients are regularly followed up to explore the type, morbidity, risk factors and treatment strategies of postoperative complication following PELD surgery. Results:There are 2 patients died in the perioperative period and 2 patients with permanent impairment of neural function after surgery, which should be the severest complication of PELD surgery. Transient paresthesia, intraoperative bleeding and dura sac tear are the most common complications reported by 6 surgeons. There are 2 suspected cases of postoperative hematoma, several cases of surgical instruments broken during the surgery and 20 cases of infection in 10120 patients, regarded as rare complications of PELD. Recurrence rate of PELD surgery is 4.7% to 6% reported by 3 surgeons. However, recurrence defined as complications of PELD surgery remain controversial. Conclusion:Excellent clinical outcome of large case series after PELD surgery is reported. However, we need to face the limitations and complications of the surgery. The complication rate should be reduced by caring about the treatment, surgical indications strictly selected and the guidance of experienced surgeons.

BackgroundTemporary unipedicle screw reduction with percutaneous kyphoplasty (TUSR-PKP) is a relatively new method for managing osteoporotic vertebral compression fractures (OVCFs). A clinical retrospective comparative study was conducted to verify whether TUSR-PKP was noninferior to simple PKP regarding the management of OVCFs.MethodsA total of 38 consecutive patients who sustained OVCFs without neurological deficits and had undergone surgeries in our hospital from June 2012 to January 2014 were included in the study: 24 patients underwent simple PKP (control group) and the other 14 patients underwent TUSR-PKP (treatment group). All 38 patients were asked to participate in a long-term (>1 year) follow-up. Visual analog scale (VAS) pain scores and Oswestry Disability Index (ODI) were recorded, and the Cobb angles and the vertebral body heights were measured on the lateral radiographs before surgery and on day 1, as well as 1, 3, 6, and 12 months after surgery.ResultsThe patients in the treatment group had better vertebral height gain and greater improvement on ODI compared with the control group (p < 0.05). The VAS scores of the two groups were similar at all points until the end of the 1‑year follow-up period. Two patients from the treatment group and 5 patients from the control group had cement leakage. In the control group, 3 patients suffered adjacent or nonadjacent vertebra fractures.ConclusionTUSR-PKP is a safe and effective surgical option for OVCFs. Compared with simple PKP, TUSR-PKP provided at least equal results for OVCFs. Moreover, during the postsurgery observations, TUSR-PKP showed potential advantages including vertebral height gain, ODI improvement, and fewer subsequent refractures.

Background A symptomatic postoperative pseudocyst (PP) is a cystic lesion that is formed in the operation area of the intervertebral disc, leading to worse symptoms. Some minority patients who developed PP experienced rapidly aggravating symptoms and could not be treated by any kind of conservative treatment. However, no clinical studies have evaluated the clinical characteristics and surgical strategies of symptomatic PP requiring a revision surgery after full-endoscopic lumbar discectomy (FELD). This study aimed to demonstrate the clinical characteristics and surgical strategies of symptomatic PP requiring a revision surgery after FELD. Methods We retrospectively analyzed the data of patients who received FELD revision surgeries due to symptomatic PP formation between January 2016 and December 2021. Common characteristics, time intervals of symptom recurrence and revision surgery, strategies for conservative treatment and revision surgery, operative time, imaging characteristics, numeric rating scale (NRS) score, Oswestry disability index (ODI) and overall outcome rating based on modified MacNab criteria were analyzed. Results Fourteen patients (males = 10, females = 4), with a mean age of 24.4 years, were enrolled. The mean time intervals of symptom recurrence and revision surgery were 43.5 and 18.9 days respectively. While the patients were conservatively managed with analgesics and physical therapy, pain persisted or progressively worsened. In comparison to the initial herniated disc, the PP was larger in 11 cases, and up- or down-migrated in four cases. The PP location included the lateral recess (n = 12), foraminal (n = 1), and centrolateral (n = 1) zones. One of the two cases treated by percutaneous aspiration (PA) was eventually treated by FELD as pain was not relieved. Follow-ups revealed an improved mean NRS score from 7.1 to 1.4, mean ODI from 68.6 to 7.9% and promising overall surgical outcomes. Conclusions The progressively severe pain experienced due to PP might be a result of its enlargement or migration to the lateral recess and foraminal zones. As complete removal of capsule is the goal, we recommend FELD instead of PA.