Risk management in posterior spinal endoscopic surgery in lumbar diseases

Minimally invasive posterior spinal endoscopic surgery has increased in popularity. However, a steep learning curve may result in a high frequency of complications. Additionally, device failure may occur during routine use. We retrospectively investigated the incidence of such safety issues in a population of patients undergoing endoscopic spinal surgery at our institution.

A total of 611 cases were included. Underlying diseases that required endoscopic surgery were lumbar disc herniation in 382 patients, lumbar spinal stenosis in 123 patients, lumbar degenerated spondylolisthesis in 100 patients, and lumbar facet joint cysts in 6 patients. Surgical complications, anatomic abnormality, and mechanical failure and/or damage of surgical instruments were considered adverse events associated with the surgery. The time period was divided into first and second halves in order to investigate the effects of the learning curve.

Complications were divided into perioperative and postoperative complications. Due to operator inexperience, complications such as intraoperative dural tear, wrong disc level surgery, and contralateral symptoms due to lack of nerve decompression were more common during the first 5 years. In contrast, no improvement was seen in the frequency of epidural hematoma in the late phase. This report indicates that during endoscopic spinal surgery, some safety issues and surgical complications are independent of surgeon experience, and may include radicular anomaly, postoperative hematoma, and mechanical damage of instruments.