General Session: Endoscopic Surgery
Presented by: J. Du - View Audio/Video Presentation (Members Only)
X. Zhang(1), Z. Huang(1), J. Du(1)
(1) General Hospital of Chinese PLA, Spine, Beijing, China
Objective: To summarize and discuss the lapsus and the treatment of the lumbarintervertebral disc herniation using percutaneous endoscopic lumbar discectomy (PELD).
Methods: Between July 2002 and October 2015, 3178 patients with lumbar intervertebral disc herniation treated byPELD were analyzed, including 2156 males, and 1022 females. Single lumbar intervertebral disc herniationwere3123 cases. double lumbar intervertebral disc herniation were 52; three lumbar intervertebral discherniation were 3. Central type in 245, side central type in 1671, lateral type in 1113, extreme lateral type in92, sequestered type in 57. These cases with complications in operation and postoperation were studiedretrospectively.
Results: There were nucleus pulposus omissions in 25 patients and 11 patients underwentopen resection of nucleus pulposus during operation immediately and the second operation was needed in7 cases, 1 case with transforaminal lumbar interbody fusion (TLIF) and the others with open resection ofnucleus pulposus. Seven patients had nerve root injury, but all completely recovered in 3-6 months afteroperation. Spinal dura mater disruption was in 7 patients, recovered after suturing of skin wound. 2985patients were followed up for 8-162months, mean follow-up time was 46 months. Postoperativespondylodiscitis was in 13 patients, recovery after expectant treatment in 1, pereutaneous puncture irrigationand drainage for continued use of local antibiotics in 8, posterior infective lumbar discectomy in 4.Postoperative relapse was in 18 patients, operated secondly by PELD in 11 and by TLIF in 7, recovery after thesecond operation. Nerve root induced hyperalgesia and burning-like nerve root pain was seen in 112 patients,the symptom was improved by analgesic drug, neurotrophy drug and physiotherapy. The effect of singlesegment PELD was not good in 32 patients with spinal stenosis, who underwent multiple segment TLIFlater.
Conclusions: The complications during operation usually are nucleus pulposus omissions, nerve rootinjury, spinaldura mater disruption. Accordingly the complications after operation include spondylodiscitis,recurrence, nerve root induced hyperalgesia or burning-like nerve root pain. Strict indication, aseptictechnique, skilled operation and proper rehabilitation exercise are effective ways to reduce complications.
Keywords: Intervertebral disk displacement; Surgical procedures, minimally invasive; Lumbarintervertebral disc herniation; Percutaneous endoscopic lumbar discectomy; Complication