Our Summary

This research paper looks into the possible complications of a type of surgery called biportal endoscopic discectomy. In simpler terms, it’s a minimally invasive procedure used to treat issues in the spine, such as a herniated disk, where surgeons use two small incisions and a camera to guide them.

The researchers combed through all the available studies on this type of surgery up until the end of 2021. They found 22 articles to review in detail.

The results showed that the complication rate of this surgery varied, ranging from 0% to close to 24% with the majority of studies reporting less than 11% complication rate. On average, the complication rate was around 5.37% among 596 patients.

The complications people experienced included issues like tears in the dura (the outermost layer of the spinal cord), bleeding, not removing enough of the problematic area, recurrence of the issue, instability, nerve-related complications (like abnormal sensations or numbness, or injury to the nerve root), a specific type of fluid-filled sac (pseudomeningocele), ascites (abnormal build-up of fluid in the abdomen), infection, bleeding in the retina, and burn injury.

Interestingly, they found that the rate of complications was higher when surgeons were still learning how to do this type of procedure.

In conclusion, the researchers feel the complication rate for this type of surgery is acceptable, but they stress the importance of surgeons being aware of the possible risks and complications to help them avoid these issues.

FAQs

  1. What is the reported complication rate of biportal endoscopic discectomy?
  2. What are some of the reported complications of biportal endoscopic discectomy?
  3. Does the complication rate of biportal endoscopic discectomy decrease with more experience?

Doctor’s Tip

A helpful tip a doctor might tell a patient about discectomy is to be aware of the potential complications that can occur during the procedure. It is important for patients to discuss any concerns or questions they may have with their surgeon before undergoing surgery. Additionally, following post-operative care instructions and attending follow-up appointments are crucial in minimizing the risk of complications and ensuring a successful recovery.

Suitable For

Patients who are typically recommended for discectomy include those with:

  1. Persistent and severe back or leg pain that has not responded to conservative treatment such as physical therapy, medications, or injections.
  2. Symptoms of nerve compression, such as weakness, numbness, or tingling in the legs.
  3. Radiating leg pain that is worse with movement or certain positions.
  4. Lumbar disk herniation confirmed by imaging studies such as MRI or CT scan.
  5. Patients who have tried conservative treatment for at least 6-12 weeks without improvement in symptoms.
  6. Patients who are medically fit for surgery and able to tolerate anesthesia.

Timeline

Before discectomy:

  1. Patient experiences symptoms of a herniated disc, such as leg pain, numbness, or weakness.
  2. Patient undergoes imaging tests, such as MRI or CT scan, to confirm the diagnosis.
  3. Patient may undergo conservative treatments, such as physical therapy or medications, to manage symptoms.

After discectomy:

  1. Patient undergoes pre-operative evaluation and preparation for surgery.
  2. Patient undergoes the biportal endoscopic discectomy procedure to remove the herniated disc material.
  3. Patient may experience complications such as dural tear, hematoma, incomplete decompression, recurrence, or neurological complications.
  4. Patient undergoes post-operative care, including pain management, physical therapy, and follow-up appointments.
  5. Patient may experience improvement in symptoms and recovery over time.

What to Ask Your Doctor

  1. What are the potential complications of a biportal endoscopic discectomy surgery?
  2. What is the typical complication rate for this procedure?
  3. How do you minimize the risk of complications during the surgery?
  4. What is the likelihood of experiencing a dural tear or hematoma during the procedure?
  5. How do you handle complications such as incomplete decompression or recurrence after the surgery?
  6. What steps do you take to prevent neurological complications such as post-op paresthesia or root injury?
  7. How do you manage complications such as pseudomeningocele, ascites, infection, retinal hemorrhage, or burn injury?
  8. Are there any specific factors that may increase the risk of complications during a biportal endoscopic discectomy?
  9. How does the complication rate vary between surgeons with different levels of experience in performing this procedure?
  10. What is the follow-up plan for monitoring and addressing any potential complications after the surgery?

Reference

Authors: Li YS, Chen CM, Hsu CJ, Yao ZK. Journal: World Neurosurg. 2022 Dec;168:359-368.e2. doi: 10.1016/j.wneu.2022.10.038. PMID: 36527215