Complications of lumbar disc herniations following trans-sacral epiduroscopic lumbar decompression: a single-center, retrospective study

Journal of Orthopaedic Surgery and Research, Dec 2017

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. 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. 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. 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.

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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)


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Seung-Kook Kim, Su-Chan Lee, Seung-Woo Park, Eun-Sang Kim. Complications of lumbar disc herniations following trans-sacral epiduroscopic lumbar decompression: a single-center, retrospective study, Journal of Orthopaedic Surgery and Research, 2017, pp. 187, Volume 12, Issue 1, DOI: 10.1186/s13018-017-0691-z