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Vol. 28. Num. 5.September - October 2017Pages 211-258
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Vol. 28. Num. 5.September - October 2017Pages 211-258
Clinical Research
DOI: 10.1016/j.neucir.2017.03.003
Fully endoscopic interlaminar and transforaminal lumbar discectomy: Analysis of 47 complications encountered in a series of 835 patients
Discectomía lumbar interlaminar y transforaminal completamente endoscópica: análisis de 47 complicaciones encontradas en una serie de 835 pacientes
Ali Güven Yörükoğlua, Burcu Gökerb,c, Alican Tahtad, Mehmet Osman Akçakayab,c,
Corresponding author
moakcakaya@gmail.com

Corresponding author.
, Aydın Aydoselie, Pulat Akın Sabancıe, Yavuz Arase, Görkem Alkırf, Altay Sencere, Murat Imere, Nail Izgie, Ali Tuncay Canbolate
a Department of Neurosurgery, Avrasya Hospital, Istanbul, Turkey
b Department of Neurosurgery, Liv Hospital, Istanbul, Turkey
c Department of Neurosurgery, Istinye University Medical Faculty, Istanbul, Turkey
d Department of Neurosurgery, Iğdır State Hospital, Iğdır, Turkey
e Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
f Department of Neurosurgery, Bakırkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Tables (3)
Table 1. Comparison of the patient details between the series and patients with complications.
Table 2. Table summarizes patient details of patients with motor deficits.
Table 3. Table summarizes the list of complications and their percentages.
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Abstract
Objective

To report perioperative complications in fully endoscopic lumbar discectomy (FELD).

Methods

From September 2010 to November 2016, 835 patients underwent FELD. In total, 865 disc levels were operated on. Of the 835 patients, the transforaminal (TF) approach was used in 174 patients, while 691 patients were operated on using the interlaminar (IL) approach. Surgical complications occurred in 47 patients, which were retrospectively analyzed.

Results

Neurological deficits occurred in six patients. In four of these six patients, deficits resolved spontaneously. In one patient, symptoms resolved after a laminectomy procedure. In only one case, the neurological deficit was permanent. Seven patients complained of dysesthesia, which resolved spontaneously with medical treatment in four patients. In the remaining two patients, dysesthesia symptoms improved after epidural and foraminal injections. Dural tears were encountered in 26 patients. Pudendal neuralgia occurred in three patients. Two cases showed wound infection. The other complications comprised one disc infection, one retroperitoneal hematoma and one wrong level surgery.

Conclusion

The FELD procedure has a steep learning curve and it is a difficult procedure to master. Surgeons should be aware of complications that can occur with the FELD procedure, most of which resolve spontaneously.

Keywords:
Fully endoscopic lumbar discectomy
FELD
Interlaminar
Transforaminal
Complications
Resumen
Objetivo

Informar las complicaciones perioperatorias en la discectomía lumbar completamente endoscópica (FELD).

Métodos

De septiembre del 2010 a noviembre del 2016, 835 pacientes fueron sometidos a FELD. Se utilizó un total de 865 niveles de disco. De los 835 pacientes, 174 pacientes fueron operados utilizando el enfoque transforaminal (TF) y 691 pacientes fueron operados en el método interlaminar (IL). Las complicaciones quirúrgicas ocurrieron en 47 pacientes que fueron analizados retrospectivamente.

Resultados

Se presentaron déficits neurológicos en seis pacientes. En 4 de 6 de estos pacientes los déficits se resolvieron espontáneamente. En un paciente, los síntomas se resolvieron después de un procedimiento de laminectomía. En un solo caso, el déficit neurológico fue permanente. Siete pacientes se quejaron de la disestesia, que se resolvió espontáneamente con la terapia médica en 4 pacientes. En los 2 pacientes restantes, los síntomas de la disestesia mejoraron después de las inyecciones epidurales y foraminales. Se encontraron lágrimas dural en 26 pacientes. La neuralgia de Pudendal ocurrió en 3 pacientes. Dos casos mostraron infección de la herida. Una infección a nivel de disco, un hematoma retroperitoneal y una cirugía de nivel incorrecto fueron las otras complicaciones.

Conclusión

El procedimiento FELD tiene una curva de aprendizaje abrupta y es un procedimiento difícil de dominar. Los cirujanos deben ser conscientes de las complicaciones que pueden ocurrir con el procedimiento FELD, la mayoría de los cuales se resuelven espontáneamente.

Palabras clave:
Discectomía lumbar completamente endoscópica
FELD
Interlaminar
Transforaminal
Complicaciones

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