2020 Volume 11 Issue 8 Pages 997-1003
Introduction: Full-endoscopic lumbar laminoplasty (FEL) is thought to be the least minimal invasive spine surgery for lumbar spinal canal stenosis (LSS), using an 8 mm diameter cannula and full-endoscopic instruments. On the other hand, several complications have been reported. In this study, a retrospective study was made to reveal the incidence of perioperative complications as well as to figure out the appropriate management of complications.
Methods: 564 patients who underwent FEL for LSS in our institute were included. The involved levels were L1/2 : 1, L2/3 : 3, L3/4 : 107, L4/5 : 440, L5/S1 : 13. Intraoperative videos, medical records including surgical records, X-ray, CT, and MRI imaging findings were retrospectively examined.
Results: Complications occurred in 53 out of 564 cases, leading to 9.4% of incidences. Dural tears occurred in 23 cases. Leg pain due to a nerve stimulation was caused by the inappropriate position of the drain tube in 9 cases. Postoperative epidural hematoma was found in 7 cases. The causes of 14 cases of postoperative cauda equina injury, including 3 with neurogenic bladder, were not identified.
Conclusions: These complications occurred at any given time during this investigation period and not just during a specific time period. Unfortunately, complications cannot be eliminated, but must be dealt with appropriately to overcome the difficulty of problem. Dural tears were caused using basket forceps; therefore, the use of basket forceps should be avoided especially during excision of the deep layers of ligamentum flavum. After the operation, the tip of the drain tube should be placed on the dorsal surface of the lamina in the lateral fluoroscopic view, and which can minimize the occurrence of pain due to a nerve root irritation. We should keep in mind the possibility of delayed onset postoperative epidural hematoma for at least several days after operation. In 14 of the cases found, the causes of postoperative injury to the cauda equina were not identified. Unintentional injury to the cauda equina may have occurred during the decompression procedure in the narrow spinal canal. So, we must pay meticulous attention to the location of the tip of the cannula in the spinal canal throughout the entire operation.
