Complications of Endoscopic Lumbar Discectomy
안광준 , 최우진 , 김관태허리사랑병원
Data of hurisarang hospital
• Period :2005. 2 ~ 2006.8 ( 1 년 6 개월 )
• Cases : 418 endoscopic discectomy
Cases ( N=418 )
L5-S1 L4-L5 L3-L4 L2-L3 L1-L2
ILD 145 21 2 0 0 168
PLD 10 195 30 12 3 250
155 216 32 12 3 418
ILD: interlaminar approach, PLD: posterolateral approach
Complications
• Vascular injury• Neural injury• Dura tear ( CSF leakage )• Infection• Recurrence• Etc
1. Anterior Vessel injury
• Incidence 0.045% / open surgery 0% / survey period
• Avoidance
Confirm always needle placement 9 inches C-arm : lateral view is more safe than AP
31/F, huge HNP L4-5 Rt
preop postop
• Very thin case : careful !
2. Nerve injury
• Incidence
0.2% / open surgery
0.2% / survey period
• Avoidance
Adhesion
Compression
Shallow Anesthesia
• Case
3. Dura tear
• Incidence 7.2% - 0.8% / open surgery
0.9% / survey period
• Avoidance Adhesion
Don’t Worry
• Case 29/ M recurred HNP L5-S1 Lt.
4. infection
• Incidence
0.13% - 0.9% / open surgery
0.4% /survey period
• Infection type
Aseptic discitis > septic discitis
• Avoidance
+ remove debris
• Case 56/M , HNP L3-4 Rt. Upward ,PreOP.
Post Op. MRI
POD # 12
5. Recurrent disc prolapse
• Incidence
5-7% / open surgery
3.1% / survey period
• Avoidance < Recommend
Remove sufficient disc Use gelfoam ?
Conclusion
• Vascular injury : lateral view • Neural injury : shallow anesthesia• Dura tear ( CSF leakage): don’t worry• Infection : debris• Recurrence : Remove sufficient disc
대단히 감사합니다 .