Complications of lumbar disc herniations following trans-sacral epiduroscopic lumbar decompression: a single-center, retrospective study
Kim et al. Journal of Orthopaedic Surgery and Research
Complications of lumbar disc herniations following trans-sacral epiduroscopic lumbar decompression: a single-center, retrospective study
Seung-Kook Kim 0 1
Su-Chan Lee 2
Seung-Woo Park 0
Eun-Sang Kim 3
0 Department of Neurosurgery, College of Medicine, Kangwon National University , Chuncheon , South Korea
1 Department of Spine Center, Himchan Hospital , 118 Yongdam-ro, Yunsoo-gu, Incheon 21927 , South Korea
2 Joint and Arthritis Research, Orthopedic Surgery, Himchan Hospital , Seoul , South Korea
3 Department of Neurosurgery, Spine center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , South Korea
Background: Trans-sacral epiduroscopic lumbar decompression (SELD) is an emerging procedure for the treatment of lumbar disc herniation (LDH), with favorable outcomes having been reported. However, the complications associated with SELD have not been comprehensively evaluated to date. Therefore, the aim of our study was to describe the incidence rate, types, and characteristics of complications following SELD and management outcomes. Methods: Retrospective analysis of the surgical and clinical outcomes for 127 patients (average age, 42.2 ± 15.2 years) who underwent SELD for LDH at L2-3, L3-4, L4-5, and/or L5-S1, performed by a single experienced spine surgeon at a single center, between January 2015 and April 2017, was conducted. Results: All procedures were successful, with a mean follow-up of 12.3 ± 2.3 months. Complications were identified in 8 patients (6.3%), including 3 cases of incomplete decompression (2.4%), 2 cases of recurrent disc herniation (1.6%), and one case each of hematoma, dural tearing, and subchondral osteonecrosis (0.8%). Among these cases with complications, only 2 cases with incomplete decompression and one case with recurrent LDH did not improve with conservative treatment and required re-operation using an open approach. The rate of complications decreased from 12.6% when considering only the first 50 cases to 2.6% for cases 51-127. Conclusions: Incomplete decompression, recurrent herniation, epidural hematoma, dural tear, and subchondral osteonecrosis were identified as complications of SELD, although the overall rate of complications was low. Practice with the procedure and careful patient selection can lower the risk of complications.
Complication; Lumbar disc herniation; Epiduroscopic; Laser decompression; Minimally invasive spine surgery; Laser spine surgery; Endoscopic spine surgery; Trans-sacral epiduroscopic lumbar decompression
Background
Lumbar intervertebral disc herniation (LDH) is a
clinically symptomatic condition caused by compression of
spinal nerve root by protruded disc material. The main
symptoms of LDH are low back pain and radiating leg
pain [
1
]. Treatment for LDH can be classified into
microscopic open lumbar microdiscectomy (OLM) or a
non-invasive pain-relieving procedure. OLM has been
regarded as the standard treatment for LDH for many
years, dating back to 1934 when Mixter and Barr
reported partial laminectomy and disc removal for the
treatment of LDH [
2, 3
]. However, this is an invasive
procedure which requires general anesthesia, skin
incision, and bone removal [3]. Owing to further exploration
of the technique of percutaneous trans-sacral pain
procedure and the development of video and surgical
instruments, trans-sacral techniques have come to be
widely used for the treatment of various spinal pain
conditions. Trans-sacral epiduroscopic lumbar
decompression (SELD) is an emerging field in research on
non-invasive pain-relieving procedures for the spine.
The underlying principle of SELD is to achieve sufficient
decompression via laser vaporization of the nucleus
pulposus, accessed through the sacral hiatus [
4, 5
]. This
technology has a unique advantage for the treatment of
centrally located disc herniations and a LDH at the level
of L5-S1. SELD is particularly useful for the treatment of
a LDH at L5-S1, which is easy to access from the sacral
hiatus because of the short distance from sacral hiatus
to the L5-S1 intervertebral disc. By comparison,
accessing a centrally located disc herniation is difficult using a
traditional open approach due to the need to interrupt
the thecal sac and nerve root. As such, spine surgeons
are increasingly interested in the application of SELD in
these cases as the technique provides a similar
procedural pathway as percutaneous epidural neuroplasty
(PEN), as well as relying on the same anatomical
references [6]. Although the use of SELD is increasing, the
types of complications, as well as the rate of these
complications, have not been clearly established. Therefore,
even though some studies have reported favorable
outcomes using SELD, because of the lack of outcome data,
SELD is not considered as the first approach for the
treatment of LDH and remains to be approved in some
countries. Therefore, the aim of our study was to
retrospec (...truncated)