Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
BMC Musculoskelet Disord. 2021 Dec 15;22(1):1041. doi: 10.1186/s12891-021-04940-z.
With the advancements in surgical methods, optical designs, and surgical instruments, percutaneous endoscopic transforaminal discectomy (PETD) has become an effective and minimally invasive procedure to treat lumbar spinal stenosis (LSS) in recent years. Few studies have focused on the complications associated with the treatment of LSS using percutaneous endoscopic lumbar discectomy (PELD). This study aimed to summarize the complications of PETD and identify the associated risk factors.
Complications in a total of 738 consecutive LSS patients who underwent single-level PETD were retrospectively recorded and analyzed between January 2016 and July 2020. In addition, a matched case-control study was designed, and according to the date of operation, the control group was matched with patients without complications, with a matching ratio of 1:3. Demographic parameters included age, sex, BMI, smoking and drinking status, comorbidity, and surgical level. The radiological parameters included grade of surgical-level disc degeneration, number of degenerative lumbar discs, grade of lumbar spinal stenosis, degenerative lumbar scoliosis, lumbar lordosis, disc angle, and disc height index. Univariate analysis was performed using independent samples t-test and chi-squared test.
The incidence of different types of complications was 9.76% (72/738). The complications and occurrence rates were as follows: recurrence of LSS (rLSS), 2.30% (17/738); persistent lumbosacral or lower extremity pain, 3.79% (28/738); dural tear, 1.90% (14/738); incomplete decompression, 0.81% (6/738); surgical site infection, 0.41% (3/738); epidural hematoma, 0.27% (2/738); and intraoperative posterior neck pain, 0.27% (2/738). Univariate analysis demonstrated that age, the grade of surgical-level disc degeneration (P < 0.001) and the number of disc degeneration levels (P = 0.004) were significantly related to the complications.
Complications in the treatment of LSS using PELD included rLSS, persistent pain of the lumbosacral or lower extremity, dural tear, incomplete decompression, surgical site infection, epidural hematoma, and intraoperative posterior neck pain. In addition, old age, severe grade of surgical-level disc degeneration and more disc degeneration levels significantly increased the incidence of complications.
随着手术方法、光学设计和手术器械的进步，经皮内窥镜椎间孔椎间盘切除术（PETD）近年来已成为治疗腰椎管狭窄症（LSS）的一种有效且微创的方法。很少有研究关注经皮内窥镜腰椎间盘切除术（PELD）治疗 LSS 相关的并发症。本研究旨在总结 PETD 并发症，并确定相关危险因素。
回顾性记录并分析了 2016 年 1 月至 2020 年 7 月期间，738 例接受单节段 PETD 的 LSS 患者的并发症。此外，还设计了一项匹配病例对照研究，根据手术日期，将对照组与无并发症的患者进行匹配，匹配比例为 1:3。人口统计学参数包括年龄、性别、BMI、吸烟和饮酒状况、合并症和手术水平。影像学参数包括手术节段椎间盘退变程度、退变腰椎间盘数量、腰椎管狭窄程度、退行性腰椎侧凸、腰椎前凸、椎间盘角度和椎间盘高度指数。采用独立样本 t 检验和卡方检验进行单因素分析。
不同类型并发症的发生率为 9.76%（72/738）。并发症及发生率如下：腰椎管狭窄症复发（rLSS）2.30%（17/738）；腰骶或下肢持续性疼痛 3.79%（28/738）；硬脊膜撕裂 1.90%（14/738）；减压不彻底 0.81%（6/738）；手术部位感染 0.41%（3/738）；硬膜外血肿 0.27%（2/738）；术中后颈部疼痛 0.27%（2/738）。单因素分析显示，年龄、手术节段椎间盘退变程度（P<0.001）和椎间盘退变水平数（P=0.004）与并发症显著相关。
PELD 治疗 LSS 的并发症包括 rLSS、腰骶或下肢持续性疼痛、硬脊膜撕裂、减压不彻底、手术部位感染、硬膜外血肿和术中后颈部疼痛。此外，年龄较大、手术节段椎间盘退变严重程度和更多的椎间盘退变水平显著增加了并发症的发生率。
