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Complications of endoscopic spinal surgery: a retrospective study of thoracoscopy and retroperitoneoscopy
Kazuyuki Watanabe1, Shoji Yabuki, Shin-Ichi Konno
1Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
Background:
Since 1996, we have applied endoscopic techniques to the treatment of various spinal disorders. The purpose of this study was to clarify the complications of endoscopic spinal surgery using thoracoscopy and retroperitoneoscopy.
Methods:
Fifty-two patients (26 male patients, 26 female patients, mean age: 49.7 years) underwent endoscopic surgery for various spinal disorders including burst fracture (20 cases), pyogenic spondylitis (10 cases), tumor (8 cases), scoliosis (4 cases), thoracic disc herniation (3 cases), and others. Thoracoscopy was performed in 20 patients, retroperitoneoscopy in 20 patients, and a combination of thoracoscopy and retroperitoneoscopy in 12 patients. Intraoperative and postoperative complications were retrospectively examined for these cases.
Results:
The intraoperative complications for thoracoscopic surgery were two cases of extensive bleeding (more than 2500 ml); for retroperitoneoscopic surgery, there were three cases of extensive bleeding and one case of penetration of the peritoneum; and for the combination of thoracoscopy and retroperitoneoscopy, there were two cases of extensive bleeding. The postoperative complications for thoracoscopic surgery were three cases of atelectasis and other respiratory complications; for retroperitoneoscopic surgery, the most common complication was transient neurological dysfunction (five cases); and for the combination of thoracoscopy and retroperitoneoscopy, three cases of atelectasis were observed. The overall incidence of complications in endoscopic spinal surgery was 42.3% (20/52 cases). Of the intraoperative complications, extensive bleeding was most frequent, and of postoperative complications, respiratory problems and transient neural damage were most frequent. The incidences of extensive bleeding and respiratory problems during the past 4 years were significantly fewer than during the first 4 years of surgical experience. Intraoperative bleeding and the operative time were significantly decreased after the first five cases of burst fracture.
Conclusions:
Complications of endoscopic spinal procedures occurred in 42.3% of our cases, but decreased with increase in surgical experience.
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