Complication Of Percutaneous Endoscopic Lumbar Discectomy For The Treatment Of Lumbar Disc Herniation

Purpose:Percutaneous endoscopic lumbar discectomy is useful for the treatment of lumbar disc herniation and is being performed in an increasing number of patients in the worldwide.The goal of this study is to analyses the intra-operative and post-operative complication of lumbar disc herniation patients who underwent the treatment by percutaneous endoscopic lumbar discectomy.Material and method:This prospective study conduct from January 2017 to January 2019,178 patients with lumbar disc herniation(LDH)underwent percutaneous endoscopic lumbar discectomy(PELD).Surgical complications were recorded in all patients intra and postoperatively.The clinical outcomes were assessed by using visual analogue scale(VAS)and Oswestry disability index(ODI)and classified the results into excellent,good,fair and poor based on modified MacNab criteria.Results:A total 178 patients underwent PELD for treatment of total 183 LDH.The operation duration was 74(range 45-128 minutes),the mean hospital stay was 6 days(2-23 days)and blood loss not measurable due to less amount of blood loss.152(85.36%)patients were follow up at least 6 month and mean period of follow up was 13.2 month(range 6-24 month).At presentation,the mean recorded score on VAS was 8.3 ± 1.2 and ODI was 77.2±13.3 respectively.At 1st day after the surgery,the score on the VAS had improved from 8.3±1.2 to 1.1±0.7(P value<0.05),and ODI from 77.2±13.3 to 24.1±8.4(P value<0.05).At final follow-up:the score on the VAS had improved from 8.3±1.2 to 1.2±0.8(P value<0.05),and ODI from 77.2±13.3 to 27.4±9.3(P value<0.05).According to MacNab criteria,]41 cases were excellent,30 were good,5 cases were fair,and 2 cases were poor.We encountered 11 complications,which included dural tear 2(1.12%)cases,nerve root injury 1(0.56%)case,neck pain 4(2.24%)cases and the incomplete disc removal 1(0.56%)case intraoperatively and post-operative discitis 1(0.56%)case and reherniation2(1.12%)cases.The incidence of surgery-related complications was 6.17%.Conclusion:The PELD technique is an effective and safe minimal invasive operative technique for treatment of LDH patients,causes less complications due to minimal operative trauma,subsequently early mobilize and stability of spine.The complication of PELD is relatively lower than open discectomy.The PELD method has steep learning curve and difficult technique to master.The complication rate should be decreased by caring the management,operative indication strictly selected and experienced minimally invasive spine surgeon.