Analysis and treatment of surgical complications after percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis

摘要

Objective To analyze the causes of surgical complications after treatment of lumbar disc herniation (LDH) and lumbar intervertebral foraminal stenosis by percutaneous transforaminal endoscopic discectomy (PTED). Methods From December 2009 to December 2014, 286 patients with LDH (N = 201) and lumbar intervertebral foraminal stenosis (N = 85) were confirmed by X-ray, CT or MRI and treated by PTED in our hospital. Visual Analogue Scale (VAS) was used to evaluate the degree of pain in each paitent before and after operation. The curative effect was evaluated by Macnab score. Surgical complications were recorded to find out the causes and methods to prevent them. Results All cases were followed up for 3 months, and the VAS score decreased significantly compared with preoperation [1.00 (0.00, 1.05) vs 8.50 (7.75, 9.25); Z = 2.825, P = 0.050]. According to Macnab score, the rate of excellent and good functional recovery was 95.45% (273/286). Procedure-related complications included nerve injury in 8 cases (2.80%), hemorrhage at the operation site and hematoma formation around nerve root in 6 cases (2.10%), rupture of dural sac in one case (0.35%), muscle cramps in 3 cases (1.05%), surgical infection in one case (0.35%), postoperative recurrence in 4 cases (1.40%). All patients with complications were cured after symptomatic treatment. Conclusions The overall effect of percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis is satisfactory, which has a low incidence rate of postoperative complications. Some tips can effectively reduce the rate of surgical complications such as preoperative evaluation, precise performance, careful hemostasis, shortening?the operation time and postoperatively symptomatic treatment, etc. DOI: 10.3969/j.issn.1672-6731.2016.04.007