Incidence of complications associated with spinal endoscopic surgery: nationwide survey in 2007 by the Committee on Spinal Endoscopic Surgical Skill Qualification of Japanese Orthopaedic Association.
BACKGROUND
This report was conducted to elucidate the current status of spinal endoscopic surgery and relevant incidents through analysis of the results of a questionnaire survey conducted in 2007 by the Committee on Spinal Endoscopic Surgical Skill Qualification of the Japanese Orthopaedic Association (JOA).


METHODS
Questionnaire forms were sent to 2011 training facilities nationwide certified by the JOA, and 1082 of these facilities returned the filled questionnaires (response rate 53.8%). Of these facilities, 257 (23.8% of the responding facilities) undertook spinal endoscopic surgery in 2007. These institutions were asked to fill in the survey form with the details of the operations and relevant incidents as well as the incident levels.


RESULTS
In total, the 257 facilities performed 6239 spinal endoscopic surgeries during 2007. Posterior spinal endoscopic surgery constituted most of the operations (6217 cases, 98.2%) including 4336 cases of microendoscopic discectomy (MED), 1273 cases of microendoscopic laminectomy or fenestration, and 379 cases of transforaminal or posterior lumbar interbody fusion. The total number of incidents was 133 (2.13%). The numbers of incidents by operative method were 75 (56.4%) during MED, 57 (42.9%) during microendoscopic laminectomy or fenestration, and 1 (0.8%) during interbody fusion. Of 133 incidents, dural tear occurred in 99 (74.4%), injury of the cauda equina or a nerve root in 7 (5.3%), facet fracture in 7 (5.3%), hematoma and wrong level in 6 each (4.5%), and wrong side and bedsore in 1 each (0.8%). The incident level was level 1 in 6, level 2 in 24, level 3a in 82, level 3b in 16, level 4 in 5, and level 5 (fatal) in 0.


CONCLUSIONS
The results of this survey revealed an increasing trend of spinal endoscopic surgery and a decreasing trend of the complication rates. The complication rates of spinal endoscopic surgery were not higher than those of conventional surgery, indicating the safety of this surgical method.
Department of Orthopaedic Surgery, Keio University, Tokyo, Japan.
Morio
M
Matsumoto
Toru
T
Hasegawa
Manabu
M
Ito
Toshimi
T
Aizawa
Shinichi
S
Konno
Masatsune
M
Yamagata
Sohei
S
Ebara
Yudo
Y
Hachiya
Hiroaki
H
Nakamura
Shoji
S
Yagi
Kimiaki
K
Sato
Akira
A
Dezawa
Muneto
M
Yoshida
Kenichi
K
Shinomiya
Yoshiaki
Y
Toyama
Katsuji
K
Shimizu
Kensei
K
Nagata
D004724:Endoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D019300:Medical Errors / Q000706:statistics & numerical data*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D013131:Spine / Q000601:surgery*