Minim Invasive Neurosurg 2007; 50(3): 145-149
DOI: 10.1055/s-2007-985152
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Surgical Complications of Microendoscopic Procedures for Lumbar Spinal Stenosis

K. Ikuta 1 , O. Tono 1 , T. Tanaka 1 , J. Arima 1 , S. Nakano 1 , K. Sasaki 1 , M. Oga 1
  • 1Department of Orthopedic Surgery, Hiroshima Red Cross and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
Further Information

Publication History

Publication Date:
19 September 2007 (online)

Abstract

Microendoscopic discectomy (MED) is one of the minimally invasive endoscopic procedures for treating lumbar disc herniation. We have applied MED techniques to posterior decompression procedures for treating lumbar spinal stenosis (LSS). In the present study, we examined the surgical complications in 114 consecutive patients surgically treated with MED procedures for LSS. Intraoperative complications occurred in 9 patients. Six patients (5.3%) experienced a dural tear, and three (2.6%) had a fracture of an inferior facet. Early postoperative complications occurred in 13 patients. Twelve patients (10.5%) experienced transient neurological complications. The clinical outcomes at the mean 28-month follow-up were not affected by these surgical complications. Other major complications such as nerve injury and surgical site infection were not observed. Most of the complications occurred in the initial series of patients, and the incidence of complications decreased with an increase in the surgeon's experience and the application of several preventive measures against the complications. The surgeon should undergo training when MED techniques are applied in surgical treatment in order to recognize the specific complications associated with such procedures and apply preventive measures against these complications.

References

  • 1 Foley KT, Smith MM. Microendoscopic discectomy.  Techn Neurosurg. 1997;  3 301-307
  • 2 Ikuta K, Arima J, Tanaka T, Oga M, Nakano S, Sasaki K, Goshi K, Yo M, Fukagawa S. Short-term results of microendoscopic posterior decompression for lumbar spinal stenosis.  J Neurosurg. 2005;  Spine 2 624-633
  • 3 Casper W, Campbell B, Barbier DD, Kretschmmer R, Gotfried Y. The Casper microdiscectomy and comparison with a conventional standard lumbar disc procedure.  Neurosurgery. 1991;  28 78-87
  • 4 Epstein NE, Epstein JE. Lumbar decompression for spinal stenosis. In: Frymoyer JW The Adult Spine: Principles and Practice, 2nd edn. Lippincott-Raven Publishers 1997: 2055-2088
  • 5 Mayfield FR. Complications of laminectomy.  Clin Neurosug. 1976;  42 435-439
  • 6 Lin SM, Tseng SH, Yang JC, Tu CC. Chimney sublaminar decompression for lumbar spinal stenosis.  J Neurosurg. 2006;  Spine 4 359-364
  • 7 Pqstacchini F, Cinotti G, Perugia D, Gumina S. The surgical treatment of central lumbar stenosis.  J Bone Joint Surg [Br]. 1993;  75 386-392
  • 8 Ragab AA, Fye MA, Bohiman HH. Surgery of the lumbar spine for spinal stenosis in 118 patients 70 years of age or older.  Spine. 2003;  28 348-353
  • 9 Rampersaud YR, Moro ERR, Neary MA, White K, Lewis SJ, Massicotte EM, Fehlings MG. Intraoperative adverse events and related postoperative complications in spine surgery: Implications for enhancing patient safety founded on evidence-based protocols.  Spine. 2006;  31 1503-1510
  • 10 Rish BL. A critique of the surgical management of lumbar disc disease in a private neurological practice.  Spine. 1984;  9 500-504
  • 11 Stolke D, Sollmann WP, Seifert V. Intra- and postoperative complications in lumbar disc surgery.  Spine. 1989;  14 56-59
  • 12 Thome C, Zevgaridis D, Leheta O, Bazner H, Pockler-Schoniger C, Wohrle J, Schmiedek P. Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy.  J Neurosurg. 2005;  Spine 3 129-141
  • 13 Weiner BK, Fraser RD, Peterson M. Spinous process osteotomies to facilitate lumbar decompressive surgery.  Spine. 1999;  24 62-66
  • 14 Whiffen JR, Neuwirth MG. Spinal stenosis. In: Bridwell KH, Dewald RL The Textbook of Spinal Surgery. J. B. Lippincott Company, New York 1991: 637-656
  • 15 Hiraizumi Y. Posterior endoscopic discectomy using as endoscopic lumbar discectomy system developed in Japan. In: Dezawa A, Chen PQ, Chung JY State of the Art for Minimally Invasive Spinal Surgery. Springer, Berlin, Heidelberg 2005: 117-130
  • 16 Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for lumbar spinal stenosis.  Neurosurgery (Supplement). 2002;  51 146-154
  • 17 Perez-Cruet MJ, Foley KT, Isaacs RE, Rice-Wyllie L, Wellington R, Smith MM, Fessler RG. Microendoscopic lumbar discectomy.  Neurosurgery (Supplement). 2002;  51 129-136
  • 18 Perez-Cruet MJ, Fessler RG, Penn NI. Review: Complications of minimally invasive spinal surgery.  Neurosurgery (Supplement). 2002;  51 26-35
  • 19 Podichetty VK, Spear J, Isaacs RE, Booher J, Biscup RS. Complications associated with minimally invasive decompression for lumbar spinal stenosis.  J Spinal Disord. 2006;  19 161-166
  • 20 Schizas C, Tsiridis E, Saksena J. Microendoscopic discectomy compared with standard microsurgical discectomy for treatment of uncontained or large contained disc herniations.  Neurosurgery. 2005;  57 357-360
  • 21 Yoshida M, Maio K, Nakagawa Y, Minamide A, Ando M, Kawakami M. Indication and clinical outcomes of posterior endoscopic surgery for lumbar and cervical radiculopathy.  SPINE WEEK. 2004;  , Porto: 820
  • 22 Yoshida M, Ueyoshi A, Maio K, Kawai M, Nakagawa Y. Surgical procedures and clinical results of endoscopic decompression for lumbar canal stenosis. In: Dezawa A, Chen PQ, Chung JY State of the Art for Minimally Invasive Spinal Surgery. Springer, Berlin, Heidelberg 2005: 15-24
  • 23 Nowitzke AM. Assessment of the learning curve for lumbar microendoscopic discectomy.  Neurosurgery. 2005;  56 755-761
  • 24 Huang Ti, Hsu RW, Li YY, Cheng CC. Contralateral neurologic deficits following microendoscopic lumbar surgery. Can it happen?.  Minim Invas Ther Allied Technol.. 2006;  15 311-316
  • 25 Ikuta K, Tono O, Tanaka T, Arima J, Nakano S, Sasaki K, Oga M. Evaluation of postoperative spinal epidural hematoma after puicroendoscopic posterior decompression for lumbar spinal stenosis: clinical and magnetic resonance imaging study.  J Neurosurg. 2006;  Spine 5 404-409

Correspondence

K. IkutaMD 

1-9-6 Sendainachi

Naka-ku

730-8619 Hiroshima City

Japan

Phone: +81/11/81 82 241 3111

Fax: +81/11/81 82 246 0676

Email: koikuta@mac.com

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