complications of endoscopic lumbar discectomy 안광준, 최우진, 김관태 허리사랑병원

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 .