徐少克醫師
童綜合醫院 骨科部
Introduction：
The Percutaneous endospoic disc surgery procedures increase during this decade due to improve the surgical instruments, technique and knowledge. This paper report our seven years complications of Percutaneous Endoscopic disc surgery and its management.
Material and Methods:
From May 1998 to May 2005, 480 cases with lumbar disc problems received Percutaneous Endoscopic disc surgery were recruited in this study. The whole procedure was performed under local anesthesia with pt in prone position. The from hundred two cases were diagnosed with contained & noncontained discs, 20 cases were with far lateral disc, 12 cases with recurrent disc, 10 cases with pyogenic and nonpyogenic discitis & spondylitis, 12 cases with lateral stensis and 24 cases with laser foraminoplasty.
Results & Discussions:
The mean follow-up period is 34 months (range 8-50M). The complications are 14 cases dysesthesia, 1 case minor CSF leakage, 7 cases discitis, 18 cases recurrence, one case with motor impairment loss and major vascular injury. The dysesthesia cases were treated with NSAID, steroids, foraminal epidural or sympathetic blocks and the 12 cases improve within 6 months, only two cases still suffer mild dysestehsia. One CSF leak case did not receive surgical repair only management with drain and duradom. There are six septic discitis in seven discitis, the infective orgiams are 4 pseudomonus, 2 MRSA. Two cases recived Percutaneous Endoscopic debridment and drainage and four cases received open debridement and bone graft. The infection cases wrer controlled after various operative procedures. The recurrent cases may be due to miss disc fragment or unsuccessful operation. 7 cases received open disc surgery. The high recurrence were performed.
Conclusion:
The initial learning curve may be the reason of increasing the complication rate that can discourage surgeons who are more comfortable with a familiar procedure. But those surgeous who overcome the steep learning curve and master the minimally invasive surgical techniques usually start to prefer it than traditional techniques because of the lower morbidity and equivalent efficacy. If not increase efficacy of the procedures. The surgeouns factor than become a major consideration for avoiding complications.