Sairyo K, Sakai T, Higashino K, Inoue M, Yasui N, Dezawa A
Department of Orthopedic Surgery, Teikyo University Mizonokuchi Hospital, Mizonokuchi Takatsu-ku 3-8-3,Kawasaki, Japan.
Minim Invasive Neurosurg. 2010 Aug;53(4):175-8. doi: 10.1055/s-0030-1262814. Epub 2010 Dec 3.
Endoscopic lumbar decompression is useful for the treatment of various spinal conditions and is being performed in an increasing number of patients worldwide. We reviewed the surgery-related complications in patients who underwent endoscopic surgery and discuss the learning curve for this procedure.
Since the first case in August 2000, a total of 138 patients have undergone endoscopic posterior decompression surgery. Of these, there were 74 patients with Herniated Nucleus Pulposus (HNP), 57 with Lumbar Canal Stenosis (LCS), and 7 with other conditions. From 2003 to 2005, the senior surgeon took a sabbatical, and no endoscopic surgery was conducted. We divided the cases based on the date of surgery: there were 62 patients in the early (E) group (before September 2003), and 76 in the late (L) group (from January 2006 to April 2008). We compared the incidence of surgery-related complications between 2 disease types as well as between the E and L groups.
We encountered 11 complications, which included 6 dural tears, 2 post-surgical hematomas, 2 neural complications and 1 fracture of the inferior articular process. The incidence of surgery-related complications was 8.6%. The incidences of complications were 8.1% and 9.3% for HNP and LCS, respectively, and 11.3%, and 5.3% in the E and L groups, respectively. The incidence was particularly high (16.7%) in the E group with LCS.
There is a steep learning curve for endoscopic surgery. Based on the data, surgeons should start performing endoscopic techniques for LCS after gaining enough experience of endoscopic surgery for HNP.
内镜下腰椎减压术对各种脊柱疾病的治疗很有用，且在全球范围内接受该手术的患者数量日益增加。我们回顾了接受内镜手术患者的手术相关并发症，并探讨了该手术的学习曲线。
自2000年8月首例手术以来，共有138例患者接受了内镜下后路减压手术。其中，74例为腰椎间盘突出症（HNP）患者，57例为腰椎管狭窄症（LCS）患者，7例为其他病症患者。2003年至2005年，资深外科医生休假，未进行内镜手术。我们根据手术日期对病例进行分组：早期（E）组有62例患者（2003年9月之前），晚期（L）组有76例患者（2006年1月至2008年4月）。我们比较了两种疾病类型之间以及E组和L组之间手术相关并发症的发生率。
我们共遇到11例并发症，包括6例硬脊膜撕裂、2例术后血肿、2例神经并发症和1例下关节突骨折。手术相关并发症的发生率为8.6%。HNP和LCS的并发症发生率分别为8.1%和9.3%，E组和L组的并发症发生率分别为11.3%和5.3%。LCS的E组并发症发生率特别高（16.7%）。
内镜手术有一条陡峭的学习曲线。根据数据，外科医生在获得足够的HNP内镜手术经验后，应开始对LCS进行内镜技术操作。
