Reasons and preventive measures of intraoperative errors and complications of transforaminal endoscopic surgery / 局解手术学杂志

ABSTRACT

Objective To analyze the causes of surgical errors and complications of lumbar degenerative diseases treated by transforaminal endoscopic spine system(TESSYS),and explore the treatment and prevention measures.Methods From July 2012 to January 2016,the data of 660 patients with lumbar degenerative diseases who treated with TESSYS were analyzed retrospectively,of which 528 patients were lumbar disc herniation with 192 cases of single segment(L4/L5) and 336 cases of multi-segment.Lumbar spinal stenosis in 132 cases,were lateral recess and nerve root canal stenosis.Surgical errors and complications were recorded,and analyzed the reasons and the treatment and preventive measures.Results Intraoperative errors1 case of sterile film with the dilating catheter went into the surgical area;1 case with wire fracture,and stump retention in vivo;for discography staining,the proportion of mixed solution was not enough,the leakage of excess concentration of methylene blue caused caudal nerve injury in 3 cases;expansion of the intervertebral foramen,the drilling part of the articular process was too deep and too close to the medial wall of the articular process,which caused cutting injury of nerve fiber sheath in 2 cases;after the rupture of the dura mater,the rinse solution was perfused,caused bloating,elevated intracranial pressure,elevated blood pressure and other symptoms of spinal cord hypertension in 3 cases;low dose of local anesthetic into the blood caused toxic reaction in 2 cases;total spinal cord anesthesia with paravertebral nerve root block in 1 case.Postoperative complications3 cases of nerve root edema;2 cases of free nucleus pulposus tissue;2 cases of local hematoma led to nerve root compression;1 case of intervertebral space infection and 3 cases of local skin neuritis in the puncture area.Conclusion In the process of intervertebral foramen surgery,there are some deficiency on instruments or operating skill.Therefore,rigorous treatment of each link in the perioperative period,is the guarantee of successful surgery.