General Session: Endoscopic Surgery
Presented by: J. Zeng
J. Zeng(1), T. Xie(2)
(1) West China Hospital,Sichuan University, Department of Orthopaedics, Chengdu, China
(2) Sichuan University, Dep. of Orthopaedics, Chengdu, China
Objective: To analyze the complications and reasons of percutaneous endoscopic lumbar discectomy(PELD) via interlaminar approach, and to investigate their interventions.
Methods: From January 2010 to December 2012, a total number of 479 patients with lumber disc herniation(LDH) underwent PELD via interlaminar approach after general anesthesia in our hospital, including 252 males and 227 females, with a mean age of 43 years(range 13～70 years). All patients suffer from typical low back pain and leg pain with the latter severer，and were confirmed no evidence of lumbar instability. The levels of herniation were L4/5 in 196 cases, L5/S1 in 286 cases. There were 476 cases of mono-segment LDH , 3 cases of double-level LDH, 46 cases of LDH combined with calcification, and 15 cases of LDH combined with lumbar stenosis. Those cases with complications in intraoperative and postoperative period were studied restropectively.
Results: The mean follow-up period was 36 months(range 25～59 months). The complications were found in 29 cases, with the incidence rate of 6.05% . Nucleus pulposus omissions were found in 3 cases, who suffered from central protrusion type of LDH, and underwent the procedure in the initial stage of a surgeon performing PELD. The symptom released after 3-6 weeks of conservative treatment. 2 cases suffered nerve root injury, both were L4/5 LDH combined with lumbar stenosis and had decreased muscle strength of lower limbs but recovered from Neurotrophic drugs and 1-3 months of functional training. 24 cases had postoperative dysesthesia, and the symptom was improved by Mecobalamin , Gabapentin and 3-6 weeks of rehabilitation exercise. Recurrent disc herniation occurred in 9 cases. 6 cases released their symptom after conservative treatment, 3 cases underwent fenestration discectomy and completely recovered in 3-6 months after operation.
Conclusion: Percutaneous endoscopic lumbar discectomy via interlaminar approach is effective for LDH. The complications during intraoperative and postoperative period include nucleus pulposus omissions, nerve root injury, dysesthesia and recurrent disc herniation. Strict selection of the indication, sophisticated arrangements of surgical plan and skillful manipulation are effective ways to decrease and prevent operative related complications.