Unsuccessful percutaneous endoscopic lumbar discectomy for lumbar degenerative diseases / 中华骨科杂志

ABSTRACT

Objective To analysis causes of surgical failure of percutaneous lumbar endoscopic discectomy (PLED) for lumbar degenerative diseases.Methods Forty-six patients (31males,15 females),who underwent unsuccessful PLED (including percutaneous transforaminal endoscopy discectomy,PTED;percutaneous interlamina endoscopy discectomy,PIED) or percutaneous endoscopic lumbar decompression,were included in this study.Unsuccessful surgeries included no relieve of lumbar and limb pain and numbness right after surgeries;aggravated after surgeries that need revision 1～3 moths after surgeries;new symptoms appeared after surgeries;still had severe low back pain (VAS ＞5 points) 3 months after surgeries;had recurrence of lumbar disc herniation at the same level.The average age was 46±11 years old (20-81 years old).The primary diagnosis was lumbar disc herniation in 43 cases,and lumbar spinal canal stenosis in 3 cases.Forty-two cases accepted single level surgeries,others accepted twolevel surgeries.One case underwent PLED twice,others underwent one-time surgery.Results The causes of surgical failure included misdiagnosis in 10 cases,inappropriate surgical indication in 10 cases,inappropriate surgical technique in 12 cases,recurrent disc herniation in 9 cases,and persistent low back pain in 6 cases.Misdiagnosis cases included avascular necrosis of femoral head in 2 cases,missed diagnosis of cervical myelopathy in 1 case,mental disorder in 1 case,severe central spinal canal stenosis in 3 cases,and unidentified diagnosis in 3 cases.Inappropriate surgical indication cases included performing PLED for severe central spinal canal stenosis in 3 cases,PLED for only low back pain in 6 cases,untreated responsible disc herniation at adjacent level in 1 cases.Inappropriate surgical technique cases included incomplete removal of protruded disc in 11 cases,nerve root injuryin 1 case.Conclusion The causes of surgical failure of PLED mainly included misdiagnosis,inappropriate surgical indication,incomplete removal of protruded disc,and recurrent disc herniation.Improving diagnosis and indication selecting ability may help to avoid surgical failure.