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Stadler RD, Shrestha N, Dara G, Yu A, Kurapatti M, Etigunta S, Berman D, Lee J, Cho B, Cho SK. Rare Complications in Endoscopic Spinal Surgery: A Narrative Review of Unique Cases. Global Spine J 2025:21925682251319542. [PMID: 39963940 PMCID: PMC11836960 DOI: 10.1177/21925682251319542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 01/07/2025] [Accepted: 01/26/2025] [Indexed: 02/21/2025] Open
Abstract
STUDY DESIGN Narrative Review. OBJECTIVES Endoscopic spine surgery is becoming an increasingly popular approach to treat spinal disease due to its minimally invasive nature. Although certain adverse events are well-reported within the literature, there is a scarcity of information for complications that are rare but still potentially serious. The purpose of this study is to describe these rare complications of endoscopic spine surgery and discuss management and prevention strategies. METHODS A search was conducted in PubMed and Embase to review the literature for all adverse events following endoscopic spine surgery, with no restrictions on publication year. Cohort and case report studies describing infrequently reported complications were collected for analysis. RESULTS A total of 38 studies were included which described rare complications in 93 patients following endoscopic spine surgery. These included neurological events (seizure, pseudomeningocele, pneumocephalus, upper limb palsy), vascular events (hemorrhage, hematoma, arteriovenous fistula), mechanical events (cage migration, guidewire breakage), and additional events (discal pseudocyst, pulmonary edema, arrhythmia, total spinal anesthesia). CONCLUSIONS Endoscopic spine surgery is rapidly evolving and emerging as a popular alternative to conventional approaches. Though regarded as a generally safe form of surgery, it is imperative that surgeons are aware of all complications which may occur, even those that may be infrequently reported in the literature.
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Affiliation(s)
- Ryan D. Stadler
- Department of Orthopedics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Nancy Shrestha
- Department of Orthopedics, Chicago Medical School at Rosalind Franklin University, North Chicago, IL, USA
| | - Gabriel Dara
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander Yu
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark Kurapatti
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suhas Etigunta
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Berman
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Lee
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian Cho
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Cho WJ, Kim KW, Park HY, Kim BH, Lee JS. Segmental artery injury during transforaminal percutaneous endoscopic lumbar discectomy: Two case reports. World J Clin Cases 2022; 10:12345-12351. [PMID: 36483795 PMCID: PMC9724518 DOI: 10.12998/wjcc.v10.i33.12345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Since Kambin experimentally induced arthroscopy to treat herniated nucleus pulposus, percutaneous endoscopic lumbar discectomy (PELD) has been developed. The branch of the segmental artery around the neural foramen may be damaged during PELD using the transforaminal approach. We report 2 rare cases in which segmental artery injury that occurred during PELD was treated with emergency embolization.
CASE SUMMARY In case 1, a 31-year-old man was transferred to our emergency department with left lower quadrant abdominal pain after PELD at a local hospital. Lumbar spine magnetic resonance imaging after the surgery showed a hematoma of the left retroperitoneal area and the psoas muscle area. Under suspicion of vascular injury, arteriography was performed. Pseudoaneurysm and blood leakage from the left 4th lumbar segmental artery into the abdominal cavity were identified. Emergency transarterial embolization was performed using fibered microcoils for bleeding of the segmental artery. In case 2, a 75-year-old woman was transferred to our emergency department with low blood pressure, right flank pain, and drowsy mental status after PELD at a local hospital. When the patient arrived at the emergency room, the blood pressure decreased from 107/55 mmHg to 72/47 mmHg. Low blood pressure persisted. Under suspicion of vessel injury, arteriography was performed, and the right 4th lumbar segmental artery rupture was confirmed. Emergency transarterial embolization was performed for bleeding of segmental artery.
CONCLUSION We were able to find the bleeding focus by angiography and treat the injury of the segmental artery successfully through emergency transarterial embolization.
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Affiliation(s)
- Wan-Jae Cho
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 07345, South Korea
| | - Ki-Won Kim
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 07345, South Korea
| | - Hyung-Youl Park
- Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 03312, South Korea
| | - Bo-Hyoung Kim
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 07345, South Korea
| | - Jun-Seok Lee
- Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 03312, South Korea
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Ouyang ZH, Tang M, Li HW, Zou MX, Li XL, Wang WJ, Yan YG. Full-Endoscopic Foraminoplasty Using a Visualized Bone Reamer in the Treatment of Lumbar Disc Herniation: A Retrospective Study of 80 Cases. World Neurosurg 2021; 149:e292-e297. [PMID: 33609764 DOI: 10.1016/j.wneu.2021.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has been widely used, before which foraminoplasty is necessary to widen the foramen for subsequent procedures. However, the learning curve of this technology is high, as the use of traditional reamers requires repeated intraoperative fluoroscopy. We sought to compare the clinical outcomes by using the visualized and traditional reamers in PELD foraminoplasty for the treatment of lumbar disc herniation. METHODS Eighty patients with lumbar disc herniation who were treated with PELD between 1 January 2017 and 1 January 2019 were retrospectively reviewed. The patients were randomly divided into 2 groups (40 patients in the Visualized Bone Reamer group) and (40 patients in the Traditional Bone Reamer group). Intraoperative fluoroscopy time, cannulation introduction time, visual analog scale, and Macnab criteria score were compared between the 2 groups. RESULTS The mean follow-up durations were 17.41 ± 1.47 and 18.37 ± 1.69 months in the visualized and traditional groups, respectively. The average cannulation introduction time and intraoperative fluoroscopy times in the visualized group is significantly lower than those in traditional group (29.20 ± 3.31 vs. 39.85 ± 3.98 minutes, P < 0.001; and 12.30 ± 2.38 vs. 20.65 ±3.51 seconds, P < 0.001, respectively). One patient in the traditional group required reoperation, and no complications occurred in the visualized group. There were no severe durotomies or vascular or visceral injuries. CONCLUSIONS Full-endoscopic foraminoplasty using a visualized reamer is safe and effective and can decrease intraoperative fluoroscopy time in PELD.
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Affiliation(s)
- Zhi-Hua Ouyang
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Ming Tang
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Hong-Wei Li
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Ming-Xiang Zou
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Xue-Lin Li
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Wen-Jun Wang
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Yi-Guo Yan
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China.
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Bellido-Yarlequé D, Rosadio-Portilla L, Tan-Kuong J, Bautista-Sánchez F, Zúñiga-Luna C, Cuya-Ochoa W. Massive Pulmonary Embolism due to Inferior Vena Cava Thrombosis Related to Compression by Lumbar Artery Pseudoaneurysm. A Case Report and Review of Literature. Ann Vasc Surg 2021; 74:520.e1-520.e9. [PMID: 33556505 DOI: 10.1016/j.avsg.2021.01.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Lumbar artery pseudoaneurysm (LAPA) is a pathology infrequently described in the literature. The most frequent complications are the expansion and rupture of the pseudoaneurysm. Reports of association between PE with LAPA have not yet been described. We present a 53-year-old male patient with LAPA whose expansion caused compression of the inferior vena cava and subsequently PE. He underwent mechanical thrombectomy and inferior cava vein filter placement associated with embolization of the LAPA. Despite the severe clinical profile, the patient was discharged with a favorable postoperative course without complications. This case report also includes a review of the literature.
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Affiliation(s)
- David Bellido-Yarlequé
- Department of Vascular Surgery, Guillermo Almenara Irigoyen National Hospital, Lima, Peru.
| | - Luz Rosadio-Portilla
- Department of Vascular Surgery, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
| | - Jesús Tan-Kuong
- Department of Interventional Radiology, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
| | | | - Carlos Zúñiga-Luna
- Department of Vascular Surgery, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
| | - Wernher Cuya-Ochoa
- Department of Vascular Surgery, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
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Soriano Sánchez JA, de Zavalía M, Soto García ME, Rodríguez García M, Soriano Solís S, Castañeda Gaxiola R, Guerrero Hernández M, Flores Soria ER, Romero Rangel JAI. Segmental T12 Vertebral Artery Injury Treated by Endovascular Coil Placement after Kyphoplasty for Symptomatic Spinal Angioma. Case Report of a Minimal Invasive Solution for a Complication of a Minimally Invasive Spine Procedure. World Neurosurg 2020; 141:137-141. [PMID: 32497848 DOI: 10.1016/j.wneu.2020.05.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Vertebral angioma is a tumor defined as an abnormality of vascular tissue development. It usually has an asymptomatic behavior, being present in 10%-12% of autopsies and imaging studies. CASE DESCRIPTION A 70-year-old man consulted because of a long history of low back pain. Imaging studies were compatible with vertebral angioma at T12; we decided to perform a minimally invasive surgical procedure, such as kyphoplasty. During surgery, there was a sharp decrease in pulmonary saturation, and the patient underwent a computed tomography scan evaluation confirming a left hemothorax due to segmental branch vascular injury at T12. Given the patient's poor medical condition and the complexity of an emergent open procedure in the thoracic spine, we decided to undertake a minimally invasive endovascular coil placement to repair the vascular injury. Due to a favorable outcome, we discharged the patient after 72 hours of surveillance. CONCLUSIONS Even in the case of a complication to occur, we should always consider a minimally invasive solution to solve the problem because patients undergoing these procedures correspond to elderly patients with poor medical conditions or comorbidities.
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Affiliation(s)
| | | | | | - Manuel Rodríguez García
- Neurosurgery Department, Neurological Center, ABC Medical Center, Campus Santa Fe, Mexico City, Mexico
| | - Sergio Soriano Solís
- Neurosurgery Department, Neurological Center, ABC Medical Center, Campus Santa Fe, Mexico City, Mexico
| | - Roberto Castañeda Gaxiola
- Neurosurgery Department, Neurological Center, ABC Medical Center, Campus Santa Fe, Mexico City, Mexico
| | - Manuel Guerrero Hernández
- Neurosurgery Department, Neurological Center, ABC Medical Center, Campus Santa Fe, Mexico City, Mexico
| | - Enrique Raúl Flores Soria
- Neurosurgery Department, Neurological Center, ABC Medical Center, Campus Santa Fe, Mexico City, Mexico
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Kwinta BM, Myszka AM, Bigaj MM, Dragan MR, Kenig J, Krzyżewski RM. Iatrogenic Common Iliac Vessel Injury During Routine Degenerative Lumbar Spine Surgery: Report of 2 Cases and Review of Literature. World Neurosurg 2020; 137:111-118. [DOI: 10.1016/j.wneu.2020.01.168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 12/26/2022]
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