scholarly journals Unique Complications of Percutaneous Endoscopic Lumbar Discectomy and Percutaneous Endoscopic Interlaminar Discectomy

2018 ◽  
Vol 1 (21;1) ◽  
pp. E105-E112 ◽  
Author(s):  
Ma Xuexiao
Keyword(s):  
Nerve Root ◽  
Epidural Hematoma ◽  
Surgical Techniques ◽  
Lumbar Discectomy ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Endoscopic Discectomy ◽  
Posterior Neck ◽  
Nerve Root Pain ◽  
Endoscopic Lumbar Discectomy

Background: Percutaneous endoscopic discectomy (PED) includes 2 main procedures: percutaneous endoscopic lumbar discectomy (PELD) and percutaneous endoscopic interlaminar discectomy (PEID), both of which are minimally invasive surgical procedures that effectively deal with lumbar degenerative disorders. Because of the challenging learning curve for the surgeon and the individual characteristics of each patient, preventing and avoiding complications is difficult. The most common complications, such as nucleus pulposus omission, nerve root injury, dural tear, visceral injury, nerve root induced hyperalgesia or burning-like nerve root pain, postoperative dysesthesia, posterior neck pain, and surgical site infection, are difficult to avoid; however, more focus on these issues perioperatively may be in order. Additionally, unique and unexpected complications can also occur, such as retroperitoneal hematoma (RPH), intraoperative seizures, and thrombophlebitis, among others. Objective: We aim to delineate unique complications during PED and accumulate strategies to prevent significant morbidity and improve surgical techniques. Study Design: A retrospective cohort study of patients undergoing PEID or PELD from October 2014 to January 2016. Setting: Affiliated hospitals of Qingdao University. Methods: Patients with lumbar disc herniation (LDH) who underwent PEID and PELD were retrospectively analyzed. Complications were recorded and analyzed pre and postoperatively. We assessed clinical outcomes using the visual analog scale (VAS) and Oswestry Disability Index (ODI) and classified the results into “excellent,” “good,” “fair,” or “poor” based on the modified MacNab criteria. All of the patients were followed for more than one year to evaluate their recovery from complications. Results: From October 2014 to January 2016, 426 patients with LDH underwent PEID (106 cases) or PELD (320 cases). Common complications and occurrence rates were as follows: the incomplete removal of herniated discs was 1.4% (6/426), recurrence 2.8% (12/426), nerve root injury 1.2% (5/426), dural tear 0.9% (4/426), and nerve root induced hyperalgesia or burning-like nerve root pain 2.3% (10/426); no posterior neck pain or surgical site infection occurred. Unique complications included: passage of the working channel through the spinal canal into the disc space (one case), super-elastic nerve hook caught by exiting nerve root (one case), epidural hematoma (one case), radicular artery injury and massive bleeding (one case) which was revised by micro-endoscopic discectomy, and intraoperative seizure (one case). No serious consequences occurred after active medical intervention, and most patients had good recovery by 3 months postoperatively with physical therapy. Limitations: The main limitations of this study are the retrospective study design, limited case number, and short follow-up period. Conclusions: PEDs are effective and minimally invasive methods for the surgical treatment of LDH, causing fewer complications due to the very minimal operational trauma for the muscle-ligament complex and stability of the spine. Nevertheless, because of the difficult learning curve for surgeons, lack of experience with the requisite surgical techniques, and enhanced clinical responsibility, a variety of problems may occur. Especially concerning are the unique complications mentioned here, which potentially lead to severe injury for the patient and require diligent preventive measures. Key words: Unique complications, epidural, hematoma, interlaminar, transforaminal, PEID, PELD

scholarly journals Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

2015 ◽  
Vol 39 (4) ◽  
pp. E6 ◽  
Author(s):  
Michael F. Shriver ◽  
Jack J. Xie ◽  
Erik Y. Tye ◽  
Benjamin P. Rosenbaum ◽  
Varun R. Kshettry ◽  
...  
Keyword(s):  
Systematic Review ◽  
Nerve Root ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Case Series ◽  
Wound Complications ◽  
Complication Rates ◽  
Nerve Root Injury ◽  
Lumbar Microdiscectomy ◽  
Root Injury

OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.

scholarly journals Utility of diffusion tensor imaging for guiding the treatment of lumbar disc herniation by percutaneous transforaminal endoscopic discectomy

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Jiaqi Li ◽  
Hao Cui ◽  
Zhipeng Liu ◽  
Yapeng Sun ◽  
Fei Zhang ◽  
...  
Keyword(s):  
Nerve Root ◽  
Diffusion Tensor ◽  
Lumbar Disc ◽  
Lateral Nerve ◽  
Nerve Roots ◽  
Nerve Root Injury ◽  
Post Surgery ◽  
Root Injury ◽  
Significant Difference ◽  
Endoscopic Discectomy

AbstractThe purpose of this study was to evaluate the utility of diffusion tensor imaging (DTI) for guiding the treatment of lumbar disc herniation (LDH) by percutaneous transforaminal endoscopic discectomy (PTED). We collected the clinical data of a total of 19 patients: 10 with unilateral S1 nerve root injury, 6 with unilateral L5 nerve root injury, and 3 with unilateral L5 and S1 nerve root injury. All patients underwent DTI before surgery, 3 days post-surgery, 30 days post-surgery, and 90 days post-surgery. The comparison of the fractional anisotropy (FA) values of compressed lateral nerve roots before surgery and 3, 30, and 90 days post-surgery demonstrated the recovery of nerve roots to be a dynamic process. A significant difference was found in the FA values between compressed lateral nerve roots preoperatively and normal lateral nerve roots before surgery, 3 days post-surgery and 30 days post-surgery (p < 0.05). There was no significant difference in FA values between compressed lateral nerve roots and normal ones 90 days post-surgery (p > 0.05). DTI can be used for the accurate diagnosis of LDH, as well as for postoperative evaluation and prognosis, and it is thus useful for the selection of surgical timing.

Rating Spinal Nerve Extremity Impairment Using the Sixth Edition

2009 ◽  
Vol 14 (4) ◽  
pp. 1-6
Author(s):  
Christopher R. Brigham
Keyword(s):  
Nerve Root ◽  
Spinal Nerve ◽  
Upper Extremities ◽  
Motor Deficits ◽  
Nerve Injuries ◽  
Sixth Edition ◽  
Federal Employee ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Rating Process

Abstract The AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, does not provide a separate mechanism for rating spinal nerve injuries as extremity impairment; radiculopathy was reflected in the spinal rating process in Chapter 17, The Spine and Pelvis. Certain jurisdictions, such as the Federal Employee Compensation Act (FECA), rate nerve root injury as impairment involving the extremities rather than as part of the spine. This article presents an approach to rate spinal nerve impairments consistent with the AMA Guides, Sixth Edition, methodology. This approach should be used only when a jurisdiction requires ratings for extremities and precludes rating for the spine. A table in this article compares sensory and motor deficits according to the AMA Guides, Sixth and Fifth Editions; evaluators should be aware of changes between editions in methodology used to assign the final impairment. The authors present two tables regarding spinal nerve impairment: one for the upper extremities and one for the lower extremities. Both tables were developed using the methodology defined in the sixth edition. Using these tables and the process defined in the AMA Guides, Sixth Edition, evaluators can rate spinal nerve impairments for jurisdictions that do not permit rating for the spine and require rating for radiculopathy as an extremity impairment.

Cervical Ganglia and Nerve Root Injury: Evidence for Respiratory Arrest as Initiating Injury in Pediatric Head Trauma

2014 ◽  
Vol 4 (4) ◽  
pp. 514-519
Author(s):  
Mary Ann Sens ◽  
Sarah E. Meyers ◽  
Mark A. Koponen ◽  
Arne H. Graff ◽  
Ryan D. Reynolds ◽  
...  
Keyword(s):  
Head Trauma ◽  
Nerve Root ◽  
Respiratory Arrest ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Pediatric Head Trauma ◽  
Cervical Ganglia

scholarly journals Triple Conjoined Nerve Root—An Unreported Anatomical Variant and Its Surgical Implications

2020 ◽  
Vol 9 (03) ◽  
pp. 215-218
Author(s):  
Kelly Gassie ◽  
Krishnan Ravindran ◽  
Gazanfar Rahmathulla ◽  
H. Gordon Deen
Keyword(s):  
Nerve Root ◽  
Root Anatomy ◽  
Neurological Injury ◽  
Herniated Disc ◽  
Anatomical Variant ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Conjoined Nerve Roots ◽  
High Degree ◽  
Conjoined Nerve Root

AbstractConjoined nerve roots are an infrequent and uncommon finding, rarely noted preoperatively. The conjoined root anomaly has potential for significant neurological injury during surgery. Preoperative recognition may avert disastrous nerve root injury but requires a high degree of clinical suspicion. We present the case of a 44-year-old patient with left L5/S1 radiculopathy caused by a herniated disc. During surgery we identified a triple conjoined nerve root anatomy. This anatomical variant, to our knowledge, has not been reported in literature. We describe the anatomical findings and surgical implications.

Risk of reoperation and infection after percutaneous endoscopic lumbar discectomy and open lumbar discectomy

2021 ◽  
Vol 103-B (8) ◽  
pp. 1392-1399
Author(s):  
Tae Wook Kang ◽  
Si Young Park ◽  
Hoonji Oh ◽  
Soon Hyuck Lee ◽  
Jong Hoon Park ◽  
...  
Keyword(s):  
Lumbar Disc ◽  
Surgical Techniques ◽  
Lumbar Discectomy ◽  
Infection Rates ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Primary Endpoints ◽  
Registration Number ◽  
History Of ◽  
Endoscopic Lumbar Discectomy ◽  
Reoperation Rates

Aims Open discectomy (OD) is the standard operation for lumbar disc herniation (LDH). Percutaneous endoscopic lumbar discectomy (PELD), however, has shown similar outcomes to OD and there is increasing interest in this procedure. However despite improved surgical techniques and instrumentation, reoperation and infection rates continue and are reported to be between 6% and 24% and 0.7% and 16%, respectively. The objective of this study was to compare the rate of reoperation and infection within six months of patients being treated for LDH either by OD or PELD. Methods In this retrospective, nationwide cohort study, the Korean National Health Insurance database from 1 January 2007 to 31 December 2018 was reviewed. Data were extracted for patients who underwent OD or PELD for LDH without a history of having undergone either procedure during the preceding year. Individual patients were followed for six months through their encrypted unique resident registration number. The primary endpoints were rates of reoperation and infection during the follow-up period. Other risk factors for reoperation and infection were also evalulated. Results Out of 549,531 patients, 522,640 had undergone OD (95.11%) and 26,891 patients had undergone PELD (4.89%). Reoperation rates within six months were 2.28% in the OD group, and 5.38% in the PELD group. Infection rates were 1.18% in OD group and 0.83% in PELD group. The risk of reoperation was lower for patients with OD than for patients with PELD (adjusted hazard ratio (HR) 0.38). The risk of infection was higher for patients with OD than for patients undergoing PELD (HR, 1.325). Conclusion Compared with the OD group, the PELD group showed higher reoperation rates and lower infection rates. Cite this article: Bone Joint J 2021;103-B(8):1392–1399.

scholarly journals The potential for salmon fibrin and thrombin to mitigate pain subsequent to cervical nerve root injury

Biomaterials ◽  
2011 ◽  
Vol 32 (36) ◽  
pp. 9738-9746 ◽  
Author(s):  
Christine L. Weisshaar ◽  
Jessamine P. Winer ◽  
Benjamin B. Guarino ◽  
Paul A. Janmey ◽  
Beth A. Winkelstein
Keyword(s):  
Nerve Root ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Nerve Root Injury ◽  
Root Injury
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