Analysis and preventive measures of complications of percutaneous spinal endoscopic decompression for patients with lumbar spinal stenosis in two procedures: transforaminal or posterior approach

Abstract

Objective To analyze the reasons of complications of lumbar spinal stenosis (LSS) treated by transforaminal or posterior approach percutaneous spinal endoscopic decompression (PSED), and explore the treatment and prevention strategies. Methods From Jun. 2014 to May 2016, the complications of 276 patients with LSS who treated with PSED were recorded and analyzed retrospectively. Among them, 193 patients treated with transforaminal PSED (t-PSED) and 83 patients were treated with posterior approach PSED (p-PSED). The treatment and preventive measures of the complications were summarized. Results With a mean of (14.6 ± 1.3) months’ follow-up, neither mortalities nor any major neurologic complications were occurred in each patient. While, 15 in 276 (5.4%) patients suffered complications have been encountered, included 3 cases dural tear, but no cerebrospinal fluid leakage was found after close the wound at the end of the operation; 3 cases nerve root injury, and all of them were got satisfactory results in six months; 2 cases of severe hemorrhage and 1 case of postoperative hematoma, all of the 3 cases were controlled after pressure dressing; venous hypertensive myelopathy was found in 2 cases, cured after intraoperative symptomatic treatment; 4 cases with imaging showed that the decompression was not complete, but only one of them underwent a second PSED and got satisfactory result. Conclusions PSED is a minimally invasive surgery option for treatment of patients with LSS. Whereas, as a technically demanding and complication-fraught procedure, especially for beginners, PSED should be precise evaluation and planning before operation, careful hemostasis and meticulous performance during operation, and careful management after operation to achieve satisfactory results while avoiding complications occurred. Key words: Minimally invasive spine surgery; Spinal endoscopic; Lumbar spinal stenosis; Complications; Strategies