Complications of lumbar disc herniations following trans-sacral epiduroscopic lumbar decompression: a single-center, ret
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RESEARCH ARTICLE
Open Access
Complications of lumbar disc herniations following trans-sacral epiduroscopic lumbar decompression: a single-center, retrospective study Seung-Kook Kim1,2*, Su-Chan Lee3, Seung-Woo Park2 and Eun-Sang Kim4
Abstract 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. Keywords: 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 * Correspondence: [email protected] 1 Department of Spine Center, Himchan Hospital, 118 Yongdam-ro, Yunsoo-gu, Incheon 21927, South Korea 2 Department of Neurosurgery, College of Medicine, Kangwon National University, Chuncheon, South Korea Full list of author information is available at the end of the article
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 r
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