Percutaneous endoscopic lumbar discectomy：the complications and their interventions

English Keywords:Lumbar disc herniation  Percutaneous endoscopic lumbar discectomy  Complication

English Abstract:

  【Abstract】 Objectives: To summarize and analyze the complications in percutaneous endoscopic lumbar discectomy(PELD) for lumbar disc herniation, and to investigate their interventions． Methods: A retrospective review was performed on 893 patients(524 males and 369 females) with lumbar disc herniation treated by PELD between May 2005 and December 2011. The average age was 44.3 years old. 234 patients underwent YESS and 659 underwent TESSYS. Among them, there were 46 cases with recurrent lumbar disc herniation. All of the patients had typical low back pain and leg pain which was not respond to conservative treatment for at least 3 months, and were confirmed as lumbar disc herniation or recurrence LDH and no evidence of disc calcification, lumbar body posterior bony edges separation, instability and spondylolisthesis by CT and MRI. The types of herniaton were para-central protrusion in 371 cases, lateral protrusion in 417 cases, far lateral extrusion in 37 cases, sequestration in 58 cases, and central protrusion in 10 cases. The levels of herniation were L2/3 in 4 cases, L3/4 in 26 cases, L4/5 in 552 cases, L5/S1 in 296 cases, L3/4 and L4/5 in 10 cases, L4/5 and L5/S1 in 5 cases. After local anesthesia, PELD was performed assisted by C-arm monitoring. The complications during operation and after operation were studied retrospectively． Results: The complications were found in 59 cases, with the incidence rate of 6.61%. Dural tear was found in 1 patient, which recovered after the tear repairing and covered with collagen sponge and tightly suturing the incision. Fragment omissions were noted in 6 patients, who recovered after underwent second discectomy by MED. 3 patients had nerve root injury, 2 of them recovered completely in 3-6 months after operation, however the other one showed no improvement． Postoperative spondylodiscitis was noted in 2 patients and retroperitoneal hematoma in 1 patient, all healed after conservative treatment. Postoperative dysesthesia was noted in 24 patients, which was resolved by neurotrophy and physiotherapy in 1-3 weeks. The mean follow-up period was 31.6 months(range，6-75 months). Recurrent disc herniation occurred in 22 patients, with the recurrence rate of 2.5%. 14 patients underwent second discectomy by MED, and 8 patients underwent MIS-TLIF. Conclusions: The complications in PELD are not uncommon, as a result, PELD should be indicated strictly and managed properly.