Abstract
BackgroundWith the advancements in surgical methods, optical designs, and surgical instruments, percutaneous endoscopic transforaminal discectomy (PETD) has become an effective and minimally invasive procedure to treat lumbar spinal stenosis (LSS) in recent years. Few studies have focused on the complications associated with the treatment of LSS using percutaneous endoscopic lumbar discectomy (PELD). This study aimed to summarize the complications of PETD and identify the associated risk factors.MethodsComplications in a total of 738 consecutive LSS patients who underwent single-level PETD were retrospectively recorded and analyzed between January 2016 and July 2020. In addition, a matched case-control study was designed, and according to the date of operation, the control group was matched with patients without complications, with a matching ratio of 1:3. Demographic parameters included age, sex, BMI, smoking and drinking status, comorbidity, and surgical level. The radiological parameters included grade of surgical-level disc degeneration, number of degenerative lumbar discs, grade of lumbar spinal stenosis, degenerative lumbar scoliosis, lumbar lordosis, disc angle, and disc height index. Univariate analysis was performed using independent samples t-test and chi-squared test.ResultsThe incidence of different types of complications was 9.76% (72/738). The complications and occurrence rates were as follows: recurrence of LSS (rLSS), 2.30% (17/738); persistent lumbosacral or lower extremity pain, 3.79% (28/738); dural tear, 1.90% (14/738); incomplete decompression, 0.81% (6/738); surgical site infection, 0.41% (3/738); epidural hematoma, 0.27% (2/738); and intraoperative posterior neck pain, 0.27% (2/738). Univariate analysis demonstrated that age, the grade of surgical-level disc degeneration (P < 0.001) and the number of disc degeneration levels (P = 0.004) were significantly related to the complications.ConclusionComplications in the treatment of LSS using PELD included rLSS, persistent pain of the lumbosacral or lower extremity, dural tear, incomplete decompression, surgical site infection, epidural hematoma, and intraoperative posterior neck pain. In addition, old age, severe grade of surgical-level disc degeneration and more disc degeneration levels significantly increased the incidence of complications.
Highlights
With the advancements in surgical methods, optical designs, and surgical instruments, percutaneous endoscopic transforaminal discectomy (PETD) has become an effective and minimally invasive procedure to treat lumbar spinal stenosis (LSS) in recent years
Previous studies have reported a variety of complications, such as recurrence of lumbar disc herniation (LDH), incomplete decompression, nerve root injury, dural tear, visceral injury, nerve root induced hyperalgesia or burning-like nerve root pain, postoperative dysesthesia, intraoperative seizure, posterior neck pain, surgical site infection, and instrument breakage, in the treatment of LDH using percutaneous endoscopic lumbar discectomy (PELD) [1, 2, 12,13,14]
These complications are associated with multiple factors, including recurrence of LDH (rLDH)-related risk factors, such as obesity, old age, Modic changes, low grade of surgical-level disc degeneration, high disc height index (DHI), large sagittal range of motion, and severe grade of adjacent-level disc degeneration [15,16,17,18]
Summary
With the advancements in surgical methods, optical designs, and surgical instruments, percutaneous endoscopic transforaminal discectomy (PETD) has become an effective and minimally invasive procedure to treat lumbar spinal stenosis (LSS) in recent years. Previous studies have reported a variety of complications, such as recurrence of LDH (rLDH), incomplete decompression, nerve root injury, dural tear, visceral injury, nerve root induced hyperalgesia or burning-like nerve root pain, postoperative dysesthesia, intraoperative seizure, posterior neck pain, surgical site infection, and instrument breakage, in the treatment of LDH using PELD [1, 2, 12,13,14] These complications are associated with multiple factors, including rLDH-related risk factors, such as obesity, old age, Modic changes, low grade of surgical-level disc degeneration, high disc height index (DHI), large sagittal range of motion, and severe grade of adjacent-level disc degeneration [15,16,17,18]
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