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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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Compagnone D, Mandelli F, Ponzo M, Langella F, Cecchinato R, Damilano M, Redaelli A, Peretti GM, Vanni D, Berjano P. Complications in endoscopic spine surgery: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:401-408. [PMID: 37587257 DOI: 10.1007/s00586-023-07891-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/18/2023] [Accepted: 08/06/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE This systematic review aims to investigate the complication rate of endoscopic spine surgeries, stratifying them by technique, district and kind of procedure performed. METHODS This study was conducted according to the PRISMA statement. The literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane Register, OTseeker and ScienceDirect database. Types of studies included were observational studies (cohort studies, case-control studies and case series) and randomised or quasi-randomised clinical with human subjects. No restrictions on publication year were applied. Repeated articles, reviews, expert's comments, congress abstracts, technical notes and articles not in English were excluded. Several data were extracted from the articles. In particular, data of perioperative (≤ 3 months) and late (> 3 months) complications were collected and grouped according to: (1) surgical technique [uniportal full-endoscopic spine surgery (UESS) or unilateral biportal endoscopic spine surgery (UBESS)]; (2) spinal district treated [cervical, thoracic or lumbar] and (3) type of procedure [discectomy/decompression or fusion]. Complication analysis was performed in subgroups with at least 100 patients to have clinically meaningful statistical validity. RESULTS A total of 117 full-text articles were assessed for eligibility. Of the 117 records included, 95 focused their research on UESS (14 LOE V, 33 LOE IV, 43 LOE III and five LOE II) and 23 on UBESS (three LOE V, eight LOE IV, 10 LOE III and two LOE II). A total of 20,020 patients were extracted to investigate the incidence of different perioperative and late complications, 10,405 for UESS and 9615 for UBESS. CONCLUSION The present study summarises the complications reported in the literature for spinal endoscopic procedures. On the one hand, the most relevant described were perioperative complications (transient neurological deficit, dural tear and dysesthesia) that are especially meaningful for endoscopic discectomy and decompression. On the other hand, late complications, such as mechanical implant failure, are more common in endoscopic interbody fusion. LEVEL OF EVIDENCE I.
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Affiliation(s)
| | - Filippo Mandelli
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Matteo Ponzo
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | | | | | | | | | - Giuseppe Maria Peretti
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133, Milan, Italy
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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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Choi G, Munoz-Suarez D. Transforaminal Endoscopic Thoracic Discectomy: Technical Review to Prevent Complications. Neurospine 2020; 17:S58-S65. [PMID: 32746518 PMCID: PMC7410381 DOI: 10.14245/ns.2040250.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/08/2020] [Indexed: 11/21/2022] Open
Abstract
For all the spine surgeons, thoracic disc herniations (TDHs) entrust a real challenge in terms of patient diagnosis, proper selection, surgical technique, and potential adverse events. TDHs are relatively uncommon compared to the lumbar and cervical levels. Literature reports a variable prevalence of TDHs around 6% to 40%, but less than 1% of all disk herniations are symptomatic TDHs, evidencing as a relatively unusual condition. Nowadays, transforaminal endoscopic thoracic discectomy (TETD) has been implemented as an alternative to classic open procedures with results that are as good as and, in some situations, better than those in traditional discectomy. However, the surgeon must be familiar with endoscopic lumbar spine surgery before opting to perform a TETD, considering that the learning curve is much harder. We describe all the steps and safety considerations during TETD based on the anatomic differences compared to lumbar endoscopic procedures. TETD is an effective and safe method that yields more benefits, provides a direct route to the lesion with less morbidity, and is performed in a minimally invasive way. Many severe complications related to the thoracic region could be avoided having the proper knowledge, adequate technique, and safety routes and considerations.
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Affiliation(s)
- Gun Choi
- Spine Surgery Department, Pohang Woori Spine Hospital, Pohang, Korea
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Iatrogenic vascular laceration during posterior lumbar disc surgery: a literature review. Neurosurg Rev 2020; 44:821-842. [PMID: 32399729 DOI: 10.1007/s10143-020-01311-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/14/2020] [Accepted: 04/29/2020] [Indexed: 11/27/2022]
Abstract
Iatrogenic vascular laceration is a rare but well-known complication of posterior lumbar disc surgery (PLUDS). We performed a review of the literature to evaluate the management of this life-threatening complication. A total of 54 papers containing 100 cases of vascular laceration following PLUDS between 1969 and 2018 were analyzed with our representative case with a left common iliac artery (CIA) laceration during a posterior approach for a far lateral L4-L5 disc herniation. There were 54 females and 35 males (12 cases with unreported gender) with ages ranging from 20 to 72 years. The most commonly involved spinal level was L4-L5 (n = 67). The duration from the causative surgery to the symptom of the vascular injury ranged from 0 to 50 h (mean, 7.3 h). Only 47.3% of patients underwent postoperative imaging and the most commonly injured vessel was the CIA (n = 49). Vascular repair, open surgery, and/or an endovascular procedure was performed in 95 patients. The most frequent complications were deep venous thrombosis in the leg and pulmonary emboli, where a complete recovery was seen in 75.3% of patients. The mortality rate was 18.8%. In hemodynamically unstable cases, an emergent exploratory laparotomy was life-saving even without vascular imaging, although angiography with/without endovascular intervention may be used in stable patients.
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Jacobson JP, Cristiano BC, Hoss DR. Simple Fluoroscopy-Guided Transforaminal Lumbar Puncture: Safety and Effectiveness of a Coaxial Curved-Needle Technique in Patients with Spinal Muscular Atrophy and Complex Spines. AJNR Am J Neuroradiol 2019; 41:183-188. [PMID: 31831464 DOI: 10.3174/ajnr.a6351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/21/2019] [Indexed: 01/20/2023]
Abstract
Patients with spinal muscular atrophy often have complete interlaminar osseous fusion, precluding lumbar puncture via the standard interlaminar approach. Recently, we have developed a new coaxial curved-needle variation of fluoroscopy-guided transforaminal lumbar puncture for intrathecal injections in this patient population. Between October 2017 and November 2018, fifty-nine consecutive transforaminal lumbar punctures using this technique were performed in 12 patients with spinal muscular atrophy for intrathecal nusinersen injection, with a 100% technical success rate and no C1-2 punctures required. One major complication occurred, consisting of a post-dural puncture headache, which required a therapeutic transforaminal epidural blood patch. Two minor complications occurred, both of which involved inadvertent puncture of a dorsal muscular arterial branch, without clinical sequelae. A fluoroscopy-guided curved-needle transforaminal approach is an effective technique for lumbar puncture in difficult cases, such as in this cohort of patients with spinal muscular atrophy and complete interlaminar osseous fusion undergoing intrathecal nusinersen injections.
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Affiliation(s)
- J P Jacobson
- From the Department of Radiology, Neuroradiology Section, Loma Linda University Medical Center, Loma Linda, California
| | - B C Cristiano
- From the Department of Radiology, Neuroradiology Section, Loma Linda University Medical Center, Loma Linda, California
| | - D R Hoss
- From the Department of Radiology, Neuroradiology Section, Loma Linda University Medical Center, Loma Linda, California.
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Iatrogenic Lumbar Artery Injury in Spine Surgery: A Literature Review. World Neurosurg 2019; 122:266-271. [DOI: 10.1016/j.wneu.2018.10.219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022]
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