Surgical Complications of Microendoscopic Procedures for Lumbar Spinal Stenosis

Abstract

Microendoscopic discectomy (MED) is one of the minimally invasive endoscopic procedures for treating lumbar disc herniation. We have applied MED techniques to posterior decompression procedures for treating lumbar spinal stenosis (LSS). In the present study, we examined the surgical complications in 114 consecutive patients surgically treated with MED procedures for LSS. Intraoperative complications occurred in 9 patients. Six patients (5.3%) experienced a dural tear, and three (2.6%) had a fracture of an inferior facet. Early postoperative complications occurred in 13 patients. Twelve patients (10.5%) experienced transient neurological complications. The clinical outcomes at the mean 28-month follow-up were not affected by these surgical complications. Other major complications such as nerve injury and surgical site infection were not observed. Most of the complications occurred in the initial series of patients, and the incidence of complications decreased with an increase in the surgeon's experience and the application of several preventive measures against the complications. The surgeon should undergo training when MED techniques are applied in surgical treatment in order to recognize the specific complications associated with such procedures and apply preventive measures against these complications.

Operative results and learning curve: microscope-assisted tubular microsurgery for 1- and 2-level discectomies and laminectomies

“…This rate was similar to Palmer's 13 series of 135 patients undergoing tubular surgery for lumbar disc herniations, and it compares favorably to the rates reported by others, which were between 3 and 14%. 1,6,15,18,26 Our overall CSF leak rate of 6.6% was comparable to data recorded in the literature (Tables 4 and 5). None of our patients required bed rest for 12 hours and there were no delayed adverse consequences of intraoperative dural tears.…”

“…Second, our data do not include information on intraoperative fractures of the pars, which may occur, especially at the beginning of the learning curve with tubular surgery, during which orientation within the limited surgical field may be difficult. This was reported in 2.6% of cases in the series presented by Ikuta et al 6 We did not record this in our database, but we recognize this phenomenon as a potential risk. We did not see any postoperative instability in our patients requiring fusion that would have initiated further workup.…”

“…This compares favorably to the literature, in which neurological complications after microendoscopic decompression have been reported in up to 10.5% of cases. 6,18 Our overall reoperation rate was 5.7%, and all reoperations were for recurrent disc herniations. This rate was similar to Palmer's 13 series of 135 patients undergoing tubular surgery for lumbar disc herniations, and it compares favorably to the rates reported by others, which were between 3 and 14%.…”

Endoscopic posterior decompression of lumbar canal stenosis

“…Such procedures should be done after achieving sufficient experience to decrease complications. [7,8,16] Part of the offending disc is removed.…”

“…Endoscopic technique can be used effectively in LCS and lateral recess stenosis. [7][8][9][10] Endoscopic technique can be used to decompress the entire length of the nerve root from the spinal canal to the extraforaminal zone while preserving the posterior elements in foraminal stenosis. [11] Bilateral severe bony canal stenosis and unstable spine are contraindications for endoscopic decompression in LCS.…”