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.