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

doi:10.3877/cma.j.issn.1674-6899.2018.02.011

Abstract

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

Zhijun Xin, Guoquan Zheng, Wenbo Liao, Xifeng Zhang, Peng Huang. Analysis and preventive measures of complications of percutaneous spinal endoscopic decompression for patients with lumbar spinal stenosis in two procedures: transforaminal or posterior approach[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2018, 11(02): 107-112.

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References 29

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术式	中央管狭窄	侧隐窝狭窄	椎间孔狭窄
t－PSED	首选	不合适	首选
p－PSED	不合适	首选	不合适

术式	中央管狭窄	侧隐窝狭窄	椎间孔狭窄
t－PSED	首选	不合适	首选
p－PSED	不合适	首选	不合适

组别	例数	硬脊膜破裂	神经损伤	严重出血及血肿形成	类脊髓高压综合征	椎管狭窄减压不彻底	合计
A组	193	1 (0.5)	1 (0.5)	3 (1.6)	0(0.0)	3 (1.6)	8 (4.1)
B组	83	2 (2.4)	2 (2.4)	0(0.0)	2 (2.4)	1 (1.2)	7 (8.4)
χ²值	?	0.165	0.165	0.252	0.030	0.824	0.150
P值	?	1.931	1.931	1.311	4.685	0.050	2.077

组别	例数	硬脊膜破裂	神经损伤	严重出血及血肿形成	类脊髓高压综合征	椎管狭窄减压不彻底	合计
A组	193	1 (0.5)	1 (0.5)	3 (1.6)	0(0.0)	3 (1.6)	8 (4.1)
B组	83	2 (2.4)	2 (2.4)	0(0.0)	2 (2.4)	1 (1.2)	7 (8.4)
χ²值	?	0.165	0.165	0.252	0.030	0.824	0.150
P值	?	1.931	1.931	1.311	4.685	0.050	2.077

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