Perioperative complications analysis and countermeasures of biportal endoscopic lumbar intervertebral fusion

English Keywords:Endoscope-assisted lumbar fusion  Lumbar degenerative disease  Biportal endoscopy  Surgical complications

English Abstract:

  【Abstract】 Objectives: To analyze the causes of perioperative complications of biportal endoscopic lumbar intervertebral fusion(BELIF) in the treatment of degenerative lumbar disease and introduce corresponding countermeasures. Methods: 128 patients underwent BELIF and were followed up for at least 3 months. The visual analogue scale(VAS) scores and Oswestry disability index(ODI) of low back pain were recorded before the operation and during the 3-month follow-up. The total operative time and the operative time under the microscope of all the patients were counted. The perioperative complications were recorded to analyze the causes and propose countermeasures. Results: The average follow-up period was 6.8±2.5 months. The VAS score for low back pain improved from the preoperative 6.35±0.58 to 2.31±1.22 at the final follow-up(P<0.05), and the ODI improved from (48.47±13.12)% before operation to (15.22±9.55)%(P<0.05). A total of 15 cases(11.7%) of perioperative complications occurred, including: 4 cases of dural tear, no treatment during operation, and 2 were found with cerebrospinal fluid leakage, giving indwelling drainage tube until the postoperative day 5; 2 cases of nerve root injury, giving postoperative symptomatic treatment of nutritional nerve; 3 cases of postoperative hematoma, and 1 received emergency surgery to remove the hematoma and 2 received nutritional nerve treatment; 1 case had transient postoperative paresthesia and 2 cases had postoperative subcutaneous ecchymosis, which disappeared in 1-2 weeks after operation; 2 cases of segmental error under microscope, with 1 case being noticed in time, and the other was a case of L5/S1 slippage, which during operation the L5 lateral recess was mistakenly judged as the S1 lateral recess, and error was noticed after partial resection of the L5 lateral recess and facet joint without causing any further damage; 1 case of poor wound healing, which healed after 2 months of repeated dressing changes. Conclusions: The BELIF operation has a good clinical effect in the treatment of lumbar degenerative diseases, but there are certain complications in the early stage. Most complications are due to technical reasons, and the surgeon needs to be familiar with the anatomical features of the lumbar spine under the endoscope.