Complications of Percutaneous Endoscopic Lumbar Discectomy: Experiences and Literature Review

Abstract

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.

Transforaminal Endoscopic Discectomy versus Microdiscectomy for Treatment of Lumbar Disc Herniation and Associated Unilateral Sciatica: A Comparative Study

“…In the TED group, the long operative time and the The EGYPTIAN SPINE Journal higher rate of complications were maybe due to the early experience with the endoscope, which has a very steep learning curve; gradually, the complication rate was lower and the operative time became short. 3,44,46 In the current study, although there was a difference between the recurrence rates in the two groups, it was statistically nonsignificant (4% and 10% in MID and TED, resp., p = 0.960), and this was comparable to the results of Yeung and Tsou 45 (4.0%-9.7% and 4.2%-11% for MID and TED, resp.) and Kim et al 20 (6.3% and 9.5% for MID and TED, resp.).…”

“…In our study, compared to the MID group, the TED group had a longer operative time, higher rate of complications, and higher rate of recurrence that may be due to the steep learning curve; with time and more experience, the surgeons will become more familiar with the approach and such rate of recurrence and the operative time will decrease and even the overall outcome will improve as reported in the literature. 3,44,46 We can report that the main advantages of TED over MID in our study are as follows: the local anesthesia, short hospital stay, early return to work, and better postoperative back. However, several drawbacks existed, such as higher rates of recurrence and complications that need more attention and investigation to minimize them and to clarify whether they are procedure-related or surgeon-related complications.…”

“…Dysesthesia in the TED group of our study was comparable to that reported in other studies. 3,45,46 Broken surgical instruments are not an uncommon complication of the TED approach; the instrumental fatigue due to overuse and rough manipulation were the main risk factors. Different instruments, such as biopsy forceps and graspers, were broken during this study; checking every surgical instrument carefully before and after surgery could help avoid such complications.…”

Guide-Needle Angle and Sleeve Placement Evaluation on Skin Entry in Percutaneous Endoscopy Lumbar Discectomy Procedure Based on Three-dimensional Computed Tomography

“…Reduced foramen height, intraforaminal or far lateral disc herniation, and the wrong location of the working tools were all risk factors. 3,4 Next, the hemorrhagic complications reported after transforaminal PELD were minor and did not necessitate extensive care. However, the current situation was very frequent and inconvenient.…”

“…PELD indications have progressed from single lumbar disc herniation to lumbar spinal stenosis, lumbar metastatic tumor, lumbar discal cyst, and revision of recurrent lumbar disc herniation with the development of surgical methods, navigation techniques, and optical systems. 3,4 This technique uses endoscopy for visualizing disc removal. Discectomy was done by a posterolateral approach with special instruments.…”