Changkun Zheng1, Xiaodong Huang1, Jiangming Yu1, Xiaojian Ye2. 1. Department of Orthopaedics, Changzheng Hospital Affiliated to the Second Military, Medical University, Shanghai, China. 2. Department of Orthopaedics, Changzheng Hospital Affiliated to the Second Military, Medical University, Shanghai, China. Electronic address: xjyespine@smmu.edu.cn.
Abstract
BACKGROUND: Posterior percutaneous endoscopic cervical foraminotomy and diskectomy has remarkably evolved with successful results. Although percutaneous endoscopic cervical diskectomy (PECD) has gained popularity, the risk of surgical failure may be a major obstacle to performing PECD. We analyzed unsuccessful cases requiring reoperation. The objective of this article was to find common causes of surgical failure and elucidate the limitations of the conventional PECD technique. METHODS: Surgery-related complications were reviewed from the initial 252 cases of a single surgeon. The patients had cervical disk herniation or radiculopathy and underwent percutaneous endoscopic surgical management. We investigated clinical outcomes and complications. A retrospective review was performed on all patients who had undergone PECD between April 2013 and April 2016. Unsuccessful PECD was defined as a case requiring reoperation within 6 weeks after primary surgery. Chart review was done, and pre-, intra-, and postoperative radiographic reviews were performed. All unsuccessful PECD cases were classified according to the type of herniated disc, location of herniation, extruded disk migration, working channel position, and intra- and postoperative findings. RESULTS: The mean operative time was 89.4 minutes (range, 60-180 minutes). The mean intraoperative blood loss was 20.3 mL (range, 10-800 mL). Cerebrospinal fluid leakage occurred in 1 patient and healed well. The follow-up period ranged from 24 to 60 months. The mean score on the visual analog scale improved from 8.67 ± 1.30 preoperatively to 7.83 ± 1.40 at 1 month postoperatively to 1.67 ± 1.30 at the final follow-up (P < 0.05), with a recovery rate of 67.9% ± 21.2%. CONCLUSIONS: Surgeons should be aware of the specific complications for the PECD approach.
BACKGROUND: Posterior percutaneous endoscopic cervical foraminotomy and diskectomy has remarkably evolved with successful results. Although percutaneous endoscopic cervical diskectomy (PECD) has gained popularity, the risk of surgical failure may be a major obstacle to performing PECD. We analyzed unsuccessful cases requiring reoperation. The objective of this article was to find common causes of surgical failure and elucidate the limitations of the conventional PECD technique. METHODS: Surgery-related complications were reviewed from the initial 252 cases of a single surgeon. The patients had cervical disk herniation or radiculopathy and underwent percutaneous endoscopic surgical management. We investigated clinical outcomes and complications. A retrospective review was performed on all patients who had undergone PECD between April 2013 and April 2016. Unsuccessful PECD was defined as a case requiring reoperation within 6 weeks after primary surgery. Chart review was done, and pre-, intra-, and postoperative radiographic reviews were performed. All unsuccessful PECD cases were classified according to the type of herniated disc, location of herniation, extruded disk migration, working channel position, and intra- and postoperative findings. RESULTS: The mean operative time was 89.4 minutes (range, 60-180 minutes). The mean intraoperative blood loss was 20.3 mL (range, 10-800 mL). Cerebrospinal fluid leakage occurred in 1 patient and healed well. The follow-up period ranged from 24 to 60 months. The mean score on the visual analog scale improved from 8.67 ± 1.30 preoperatively to 7.83 ± 1.40 at 1 month postoperatively to 1.67 ± 1.30 at the final follow-up (P < 0.05), with a recovery rate of 67.9% ± 21.2%. CONCLUSIONS: Surgeons should be aware of the specific complications for the PECD approach.