How to avoid the consequences of failure of perforaminal endoscopic lumbar discectomy?

Perforaminal endoscopic lumbar discectomy is a relatively advanced technology for the treatment of spinal diseases. This technology is very powerful and can relieve a lot of patients' pain. The treatment effect is very outstanding and the patient's recovery period is greatly shortened. However, no technology is 100% effective. Some patients fail during perforaminal endoscopic lumbar discectomy for various reasons, resulting in more serious consequences. Let’s take a look at how to avoid the consequences of failure of perforaminal endoscopic lumbar discectomy.

1. Since the surgical incision is small, the exposure is less, and the operating space is limited, the probability of positioning error is theoretically higher than that of traditional surgery. As a result, the actual intervertebral disc disease could not be treated and the original nerve root compression symptoms before the operation could not be relieved.

(1) Before surgery, the patient’s medical history should be inquired in detail, signs of nerve root involvement should be carefully examined, and the location, nature, and degree of the disc herniation should be preliminarily determined.

(2) Repeatedly read the lumbar spine AP and lateral radiographs, CT and MRI to determine the exact location of the intervertebral disc herniation; understand whether there is lumbar sacralization, sacral lumbarization, lumbar vertebral deformity, etc.; here, the correspondence between the spinous process and the interlaminar space and between the interlaminar space and the intervertebral space should also be understood.

(3) Before surgery, the spinous process or interspinous process space corresponding to the lesion gap is routinely marked on the body surface with a metal pin, and then a lumbar spine positioning film or spot film is taken. Oblique film was marked with gentian violet for intraoperative reference.

(4) During the operation, based on the above data, a fine needle is used under a C-arm X-ray machine to locate the affected intervertebral space.

Second, microscopic bleeding is often encountered, which often causes secondary damage or affects the progress of nucleus pulposus removal due to heavy bleeding and unclear vision. Common causes of bleeding include:

(1) Coagulation disorder: Therefore, a detailed examination of bleeding, coagulation time and platelet function should be performed before surgery.

(2) Intraspinal vein rupture: When entering the spinal canal to explore the nerve roots and intervertebral discs, the swollen venous plexus often bleeds, which is sometimes difficult to stop.

Prevention methods :

(1) Before surgery, the patient should be positioned appropriately so as not to compress the intra-abdominal veins.

(2) Careful observation should be made during the operation, and gentle techniques should be used when examining the nerve roots.

(3) The thicker veins around the nerve roots should be protected from damage as much as possible. In such cases, they should be exposed carefully to reduce unnecessary impact with the operating instruments.

(4) For larger intraspinal veins that cannot be avoided, bipolar electrocoagulation can be used to burn both ends of the blood vessel before treatment.