Incomplete decompression of herniated discs: A combination of instruments and devices such as various nucleus pulposus clamps, disc chisels, and thermocoagulated disc molding can reduce the incidence of this complication.
Nerve injury: Nerve injury is rare in minimally invasive spine surgery. Although nerve root injury may occur, it can be avoided by intraoperative patient pain feedback and endoscopic direct visual monitoring. Surgery performed strictly within the safety triangle can avoid exposure and injury to the nerve roots. Sympathetic nerve injury is much less likely because the procedure is primarily confined to the intradiscal and intervertebral foramina. The use of local anesthesia and doctor-patient verbal communication can provide further safety reminders.
Visualized endoscopic and C-arm X-ray monitoring of delicate procedures can reduce the incidence of complications.
Surgery at the wrong segment: A major complication of all disc surgeries in the spine is surgery at the wrong segment. C-arm radiography and proper anatomic positioning can prevent surgery at the wrong segment. Routine pain-inducing tests and discography can reconfirm the accuracy of the operated segment.
Infection: Strict sterilization techniques, smaller surgical incisions, absence of prolonged soft tissue traction, and prophylactic intravenous antibiotics can prevent infection.
Discitis: prophylactic application of antibiotics, preservation of continuous irrigation throughout the procedure, and introduction of surgical instruments via working cannulae can reduce the incidence of infectious discitis.
Aseptic discitis: avoiding intraoperative injury to the endplate can reduce the incidence of aseptic discitis.
Vascular injury: injury to large vessels such as the aorta, inferior vena cava and femoral artery can be avoided by always keeping the puncture needle and working trocar in the intervertebral space and safe triangular working area.
Intestinal and ureteral injuries: there have been no reports of ureteral injuries
Cerebrospinal fluid leak or dural injury: multicenter studies have shown that the incidence of cerebrospinal fluid leak and dural injury is less than 1%.
Since open surgery is performed under general or epidural anesthesia, it is only at the end of the procedure when the anesthetic has completely lost its effect that we know if
nerve injury. The surgery is performed under local anesthesia under conscious sedation combined with doctor-patient verbal communication is the guarantee of surgical safety.
Soft tissue injury: Soft tissue injury caused by prolonged soft tissue pulling in conventional open surgery is not seen in this procedure.
Indications – Percutaneous endoscopic lumbar disc removal surgery is suitable for the following conditions.
Intractable low back pain with radiating pain in the lower extremities.
Symptoms of spinal neurogenic claudication.
Compressive and irritating neurogenic symptoms, sensory and motor dysfunction.
A prolapsed or free disc with significant low back pain.
Spinal degeneration and spinal stenosis with significant low back pain hip pain or leg pain.
Persistent low back pain that is ineffective for synovial joint closure.
Lateral saphenous stenosis with dynamic compression of radiculopathy symptoms.
Previous failed conventional surgery with perineural scar formation and
failed lumbar spine surgery syndrome.
At least 12 weeks of conservative treatment has failed.
Diagnostic imaging MRI, CT, 3DCT, CTM, etc. showing
Disc herniation, prolapse or lateral saphenous fossa stenosis.
Positive preoperative or intraoperative discography and pain provocation test.
Multi-segmental disc disease can be resolved with percutaneous foraminoplasty in a single
minimally invasive solution.