title: [Complication and treatment of the lumbar intervertebral disc herniation using percutaneous endoscopic lumbar discectomy].
abstract: OBJECTIVE
  To summarize and discuss the lapsus and the treatment of the lumbar intervertebral disc herniation using percutaneous endoscopic lumbar discectomy (PELD).
  
  
  METHODS
  Between July 2002 and October 2010, 689 patients with lumbar intervertebral disc herniation treated by PELD were analyzed, including 448 males, and 241 females. Single lumbar intervertebral disc herniation were 669 cases. double lumbar intervertebral disc herniation were 19; three lumbar intervertebral disc herniation were 1. Central type in 66, side central type in 365, lateral type in 242, extreme lateral type in 10, sequestered type in 6. These cases with complications in operation and postoperation were studied retrospectively.
  
  
  RESULTS
  There were nucleus pulposus omissions in 5 patients and 2 patients underwent open resection of nucleus pulposus during operation immediately and the second operation was needed in 3 cases, 1 case with transforaminal lumbar interbody fusion (TLIF) and the others with open resection of nucleus pulposus. Two patients had nerve root injury, but all completely recovered in 3 - 6 months after operation. Spinal dura mater disruption was in 2 patients, recovered after suturing of skin wound. All 689 patients were followed up for 6 - 96 months, mean follow-up time was 33 months. Postoperative spondylodiscitis was in 7 patients, recovery after expectant treatment in 1, percutaneous puncture irrigation and drainage for continued use of local antibiotics in 4, posterior infective lumbar discectomy in 2. Postoperative relapse was in 6 patients, operated secondly by PELD in 4 and by TLIF in 2, recovery after the second operation. Nerve root induced hyperalgesia and burning-like nerve root pain was seen in 19 patients, the symptom was improved by analgesic drug, neurotrophy drug and physiotherapy. The effect of single segment PELD was not good in 10 patients with spinal stenosis, who underwent multiple segment TLIF later.
  
  
  CONCLUSIONS
  The complications during operation usually are nucleus pulposus omissions, nerve root injury, spinal dura mater disruption. Accordingly the complications after operation include spondylodiscitis, recurrence, nerve root induced hyperalgesia or burning-like nerve root pain. Strict indication, aseptic technique, skilled operation and proper rehabilitation exercise are effective ways to reduce complications.
authors.affiliation: Department of Orthopedics, the Affiliated Central People's Hospital of Tengzhou of Jining Medical College, 277500 Tengzhou, China.
authors.forename: Bing-tao
authors.initials: BT
authors.lastname: Wen
authors.forename: Xi-feng
authors.initials: XF
authors.lastname: Zhang
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Song-hua
authors.initials: SH
authors.lastname: Xiao
authors.forename: Zheng-sheng
authors.initials: ZS
authors.lastname: Liu
authors.forename: Bao-wei
authors.initials: BW
authors.lastname: Liu
authors.forename: Yong-gang
authors.initials: YG
authors.lastname: Zhang
authors.forename: Jang
authors.initials: J
authors.lastname: Song
authors.forename: Yan-xue
authors.initials: YX
authors.lastname: Zhong
authors.forename: Jian-hua
authors.initials: JH
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017587:Diskectomy, Percutaneous / Q000009:adverse effects* / Q000379:methods; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007431:Intraoperative Complications; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult