In the past, the use of endoscopic spine surgery was limited to intervertebral discectomy; however, it has recently become possible to treat various spinal degenerative diseases, such as spinal stenosis and foraminal stenosis, and the treatment range has also expanded from the lumbar spine to the cervical and thoracic regions. However, as endoscopic spine surgery develops and its indications widen, more diverse and advanced surgical techniques are being introduced, and the complications of endoscopic spine surgery are also increasing accordingly. We searched the PubMed/MEDLINE databases to identify articles on endoscopic spinal surgery, and key words were set as “endoscopic spinal surgery,” “endoscopic cervical foramoinotomy,” “PECD,” “percutaneous transforaminal discectomy,” “percutaneous endoscopic interlaminar discectomy,” “PELD,” “PETD,” “PEID,” “YESS” and “TESSYS.” We analyzed the evidence level and classified the prescribed complications according to the literature. Endoscopic lumbar surgery was divided into full endoscopic interlaminar and transforaminal approaches and a unilateral biportal approach. We performed a comprehensive review of available literature on complications of endoscopic spinal surgery. This study particularly focused on the prevention of complications. Regardless of the surgical methods, the most common complications related to endoscopic spinal surgery include dural tears and perioperative hematoma. transient dysesthesia, nerve root injury and recurrence. However, Endoscopic spinal surgery, including full endoscopic transforaminal and interlaminar and unilateral biportal approaches, is a safe and effective a treatment for lumbar as well as cervical and thoracic spinal diseases such as disc herniation, lumbar spinal stenosis, foraminal stenosis and recurrent disc herniation.
As life expectancy increases, the number of patients with degenerative spinal diseases is increasing worldwide [
In the past, the use of endoscopic spine surgery was limited to intervertebral discectomy, however, it has recently become possible to treat various lumbar degenerative diseases such as lumbar spinal stenosis and foraminal stenosis, and the treatment range has expanded from the lumbar spine to the cervical and thoracic regions. However, as endoscopic spine surgery develops and its indications widen, more diverse and advanced surgical techniques are being introduced, and the complications of endoscopic spine surgery are also increasing accordingly.
Still now, literatures on the complications of endoscopic spinal surgery are very rare. Therefore, this study aimed to conduct a literature review of the complications of endoscopic spinal surgery and to predict the prognosis for the incidence of complications, and solutions to complications related to endoscopic spinal surgery.
The PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines were used as templates for this systematic review. These guidelines are an evidence-based minimum set of items aimed at helping authors improve the reporting of systematic reviews and meta-analyses. The review process started with a search of the PubMed and Cochrane databases to identify articles on spinal stenosis and endoscopic decompression protocol. A reviewer assessed all articles and references and agreed on which articles should be included. To prevent selection bias during the review, abstracts from the search were numbered and pasted onto a document after deleting the publication journal, author, and institution. The initial search included the keywords “endoscopic spinal surgery,” “endoscopic cervical discectomy,” “endoscopic cervical foraminotomy,” “endoscopic lumbar discectomy,” and “endoscopic lumbar decompression,” which yielded 494 results. After duplicates were identified and removed, 421 articles were obtained.
The search also included the exact surgical technique term “endoscopic spinal surgery” and returned 188 articles published between 1980 and 2021. The exclusion criteria included no reported complication results (57 articles), microendoscopic surgery (23 articles), metastasis (7 articles), and studies not in English (7 articles). A total of 94 articles that met our inclusion criteria were identified through the search process and analyzed (
To date, randomized controlled trials (RCTs) on full endoscopic surgery have been scarce. There were only 3 RCTs for 2 full endoscopic interlaminar lumbar decompressions and full endoscopic cervical approaches. No RCT has compared full endoscopic transforaminal and interlaminar approaches and unilateral biportal approaches with complications. Therefore, direct meta-analysis was not possible for either method, and only a narrative analysis was performed.
A total of 103 articles related to complications of endoscopic spinal surgery were reviewed and analyzed.
Complications of full endoscopic surgery were reported in 38 articles in cervical spinal disease, 4 on complications of full endoscopic cervical surgery (
Twelve articles on complications of endoscopic thoracic spinal surgery were reported, 2 on review articles of full endoscopic thoracic surgery (
Complications of lumbar endoscopic surgery were reported in 53 articles on full endoscopic lumbar decompression. Regardless of the transforaminal or interlaminar approach method, complications of full endoscopic lumbar decompression were reported in a total of 5 studies (
A total of 24 studies reported complications for full endoscopic transforaminal lumbar decompression (
The overall incidence of clinically symptomatic complications is below 10%. Most complications were minor, and life-threatening complications, such as thromboembolism, sepsis, severe bleeding, or pulmonary complications are less frequent than open surgery. The complications of endoscopic cervical surgery at approximately 5% with both anterior and posterior approaches had an incidence equivalent to that expected from open cervical surgery.
According to the complication analysis of endoscopic spinal surgery, regardless of the cervical, thoracic or lumbar spine, regardless of the uniportal or biportal approach, main complications such as dural tears, postoperative hematoma, neurological irritation (dysesthesia), untreated pain are commonly reported.
Regardless of the cervical anterior or posterior approach method, several literatures on the complications of full endoscopic cervical surgery have already been reported. According to the analysis of complications of endoscopic spinal surgery, Guo et al. [
In posterior endoscopic cervical surgery, transient dysesthesia, neck pain, and nerve (spinal cord and dura) injuries are comparatively common complications.
Gibson et al. [
In endoscopic transforaminal thoracic surgery, intercostal neuralgia is unique complication. Other common complications include neurological injury, vascular injury, visceral injury, recurrence, dysesthesia, and incomplete decompression. In endoscopic interlaminar thoracic surgery, dural tears, transient paralysis, and dysesthesia were relative common complications.
In thoracic spine endoscopic surgery, motor weakness due to the deterioration of myelopathy has been reported as a complication, requiring careful and meticulous techniques.
Regardless of the lumbar transforaminal or interlaminar approach method, literatures on the complications of full endoscopic surgery have already been reported [
Lee et al. [
Lin et al. [
Fan et al. [
Ju et al. [
In UBESS, Liang et al. [
In addition, Wang et al. [
Summing up several papers on complications of endoscopic spine surgery, the most common complications of endoscopic spine surgery are dural tears, epidural hematoma, transient dysesthesia, and incomplete decompression.
This study also discusses the treatment method for each complication, along with the thesis review.
Dural damage is the most common complication of endoscopic spinal surgery, and it can lead to serious complications if an accurate diagnosis and appropriate treatment are not performed. The overall rate of dural tears in endoscopic spinal surgery was 2.7%, range from 0% to 8.6% [
Pan et al. [
However, Klingler et al. [
In UBESS, Liang et al. [
Several methods have been introduced for the treatment of incidental dural tears during endoscopic spinal surgery. An autologous muscle or fat graft in combination with fibrin glue or a fibrin-sealed collagen sponge seems to be a good and safe method for the management of dural tear in lumbar endoscopic spine surgery [
Kim et al. [
Nam et al. [
An epidural hematoma occurs mainly after an interlaminar approach. Recently, as endoscopic surgery for spinal stenosis and intervertebral discectomy has increased, the complication rate has also increased. It is also one of the most common complications in biportal endoscopic surgery.
The incidence of postoperative epidural hematoma is approximately 0.27%. Continuous saline irrigation is necessary during biportal endoscopic spine surgery [
There are 2 possible mechanisms of increased epidural and intracranial pressure by continuous saline irrigation [
Although symptomatic postoperative epidural hematoma is relatively rare (the incidence rate is 0.02% to 4.6%) [
Ahn et al. [
Kim et al. [
Additionally, Kim et al. [
Symptomatic postoperative spinal epidural hematoma is a devastating complication that could develop after biportal endoscopic spine surgery [
Although rare, hematomas can occur as a result of vessel injury during the full endoscopic transforaminal approach. A small amount of bleeding is not a problem even with conservative treatment, however, if the segmental artery branch is damaged, a large retroperitoneal hematoma may occur and cause symptoms. To avoid blood vessel damage, it is important to carefully insert the needle into the relatively safe avascular area by touching the bone of the facet in the safety zone during the transforaminal approach [
In addition, because damaged blood vessels may not be seen well in the field of view of endoscopic surgery when the endoscope is removed after the surgery, it is necessary to check slowly that there is no bleeding in the surrounding tissue. Bleeding control during surgery is the most important thing, and when bleeding occurs, the method using the radiofrequency probe is mainly used, or another electrocautery or bone wax is used when there is bone bleeding. However, in cases of severe bleeding, it is often difficult to identify the bleeding site because it is difficult to secure a visual field. At this time, a hemostatic agent such as GTMS, can be helpful, and while the surgical field is secured for a while with the hemostatic agent, you must check the bleeding site and perform sufficient hemostasis with radiofrequency or other electrocautery before leaving. Additionally, if bleeding continues even after hemostasis, Hemovac drainage after surgery can be a good way to prevent hematoma.
Postoperative dysesthesia often occurs in the transforaminal approach, and this surgical method can be caused by direct irritation of the exiting nerve root that anatomically borders the safety zone.
Ju et al. [
Silav et al. [
For the prevention of postoperative dysesthesia, the foraminoplasty is performed to expand the safety zone without causing an exiting nerve root irritation [
In biportal endoscopic surgery. the incidence of transient paresthesia is approximately 0.14% [
Whether resection of the herniated disc is complete depends on the position of the working cannula, type of disc herniation, and size of the herniated fragments. Incomplete discectomy is particularly common in downward migration or high canal compromised disc herniation. Choi et al. [
In the transforaminal approach, the foraminoplastic technique is a safe and reliable method for discectomy, and the migrated disc can be easily removed using a curved probe or forceps. Because the field of view of endoscopic surgery is narrow, it may not be possible to check the lesion area, and dura free pulsation must be checked to ensure sufficient decompression.
During spinal stenosis decompression, unilateral and bilateral decompression should be performed to sufficiently decompress the superior articular process in the lateral recess area to confirm the traversing nerve root, and sufficient laminectomy is required for sufficient decompression.
Decompression is usually excellent in UBESS for lumbar spinal stenosis. However, decompression may be inadequate in patients with severe lumbar spinal stenosis. Deviations in the preoperative assessment and intraoperative decompression range have been the main reasons for inadequate decompression [
Intraoperative irregularities and thermal injuries from radiofrequency ablation have been the main causes of nerve root injury. The use of an arthroscopic radiofrequency ablation tip in the spinal canal can cause significant thermal damage to the neural structures. Therefore, it is important to be gentle during the procedure, to identify nerve structures carefully, and to reduce the voltage of the radiofrequency device if necessary [
Recurrent lumbar disc herniation (LDH) is defined as a recurrence of disc herniation at the same site of a previous discectomy in a patient who has experienced a pain-free interval after surgery. However, the minimum length of the pain-free interval is debatable, ranging from any interval of pain resolution to 6 months [
The purpose of PELD is not to remove nucleus pulposus totally but to remove partially the herniated disc fragments and decompress nerve root. Therefore, recurrence of LDH sometimes occurs with aging, inappropriate weight-bearing, and other factors like male gender, obesity (body mass index [BMI] ≥ 25 kg/m2), old age (≥ 50 years), trauma history, and central disc herniation. But PELD also has some unique risk factors for LDH recurrence, such as surgeons’ having less experience with PELD (≤ 200 cases) and performing operations in the early development stage of PELD [
With UBESS via the interlaminar approach, the use of high intraoperative water pressure can increase cerebrospinal fluid pressure and intracranial pressure, leading to postoperative headache and can even induce seizures [
The incidence of intervertebral infection after spine surgery ranges from about 0.1% to 4.5%, most cases are caused by bacterial infection [
Gu et al. [
Postoperative segmental instability or facet joint injury is another complication of biportal endoscopic laminotomy [
Cervical and thoracic endoscopic spinal surgery is currently performed in hospital in the Far East, but is not popular in Europe or the United States. Attempts were made to remove cervical discs with minimally invasive anterior approaches in the 1990s, but the techniques used were not widely adopted because the inherent risks associated with the surgical approach and the lack of well-designed equipment [
Although it is well recognized that posterior cervical lamino-foraminotomy for discectomy and root decompression with foramen widening will minimize blood loss and enhance patient recovery compared to anterior cervical surgery, the benefits regarding clinical outcomes are less well established [
This is because a various posterior surgical methods have been used by surgeons, from microsurgery with tubular retractors to purely endoscopic techniques [
Surgical complications of approximately 5% in both the anterior and posterior approaches were the same as expected in open cervical surgery, and there appeared to be a low rate of reoperation. The posterior approach may reflect the generally shorter clinical follow-up [
Choi et al. [
In the anterior cervical approach, the essential technical factor is the precise targeting of disc pathology. The surgeon should feel the carotid pulse and push the anterior neck down into the space between the carotid artery and tracheoesophagus until the fingertips touch the anterior surface of the vertebral body [
In the posterior cervical approach, a definitive dissection of bony structures and identification of the laminofacet junction (so-called “Y-point”) is essential for a safe and precise cervical foraminotomy. To prevent postoperative instability, the extent of facetectomy should be limited to no more than 50% of the facet joint. After adequate foraminotomy, the herniated foraminal disc fragment should be removed while preventing a dural tear. The dissection between the herniated disc and the neural tissues can be performed with a blunt dissector. The exposure of herniated fragment with firm nerve retraction can be achieved by rotating the bevel ended tip of the working cannula. After adequate nerve retraction, the herniated piece can be removed by endoscopic forceps and supplementary radiofrequency or laser. Epidural bleeding may occur from flourishing venous plexus. A gentle tamponade with hemostatic agents or hydrostatic pressure may be useful with a bipolar coagulator [
In thoracic endoscopic spinal surgery, 3 main complications of thoracic endoscopic surgery were reported: (1) neurological injury like damage to the spinal cord and its nerve roots, (2) vascular injury like damage to the inferior vena cava or thoracic aorta can be life threatening, (3) visceral injury like damage to the lung or mediastinal viscera [
Recently, endoscopic spinal surgery has expanded from lumbar discectomy to lumbar spinal stenosis decompression and foraminal stenosis decompression as the transforaminal and interlaminar approaches are advanced, respectively. In addition, endoscopic spinal surgeries have become possible from the lumbar spine to the cervical and thoracic spine, and various endoscopic surgical techniques are still being introduced and rapidly developing.
However, in spite of various advantages, endoscopic surgery does not yield good results for all spinal diseases, and it is important to select the appropriate surgical indications to obtain successful surgical results. The indications for endoscopic spinal surgery show slight differences depending on the interlaminar and transforaminal approach.
Choi et al. [
In full endoscopic posterior cervical foraminotomy, good indications were foraminal disc herniations (predominantly unilateral arm pain), single or multilevel foraminal stenosis (unilateral arm pain), persistent symptoms despite previous anterior cervical discectomy and fusion. On the other hand, axial neck pain, instability, and cervical kyphosis were contraindications [
Lewandrowski et al. [
Also, Wagner et al. [
Ju et al. [
Heo et al. [
For successful endoscopic spinal surgery, it is most important to understand the advantages and disadvantages of endoscopic approach methods and to select the most effective and convenient surgical approach for the disease.
The endoscopic spinal surgery has developed rapidly as new delicate techniques have been introduced. The transforaminal endoscopic surgery developed into foraminoplasty with the spread of endoscopic drills, enabling decompression of foraminal stenosis at the surgical site, which was previously limited to discectomy. In addition, with the development of an interlaminar approach to drill-assisted laminectomy, bilateral and contralateral decompression has become possible. However, as the scope of endoscopic surgery is widen, high-level surgical skills are required and difficult, and the complications of endoscopic surgery are also increasing.
According to our study, the incidence of complications was similar between the transforaminal and interlaminar approaches, regardless of cervical, thoracic and lumbar endoscopic surgery. However, the incidence of some complications depends on the surgical approach and method.
In cervical endoscopic spine surgery, the anterior approach and posterior approaches are used. Since the anterior approach is similar to open surgery, there is an anatomically high risk of damage to the anterior structures of the spine, which can cause swallowing difficulties and complications such as hematoma and hoarseness. On the other hand, in the posterior approach, many complications such as nerve root injury, hematoma, and dysesthesia occur as the nerve root is exposed and needs to be managed during foraminotomy.
The surgical approach for the thoracic spine is subdivided into various methods due to its complex anatomical structure, however, in endoscopic surgery, it can be largely divided into transforaminal and interlamiar approaches.
In the full endoscopic thoracic transforaminal approach, it is necessary to enter between the ribs and access the epidural space through foraminoplasty, which can cause intercostal nerve injury from the moment the endoscope is inserted. Stimulation of or damage to the spinal cord during performance can cause serious complications that exacerbate myelopathy.
The interlaminar thoracic approach requires decompression of the spinal cord using a curret and Gerison punch after sufficient laminectomy as open surgery. In a state where sufficient laminectomy is not performed, it is dangerous because it can compress and damage the spinal cord during the process of inserting a curret, drill, or punch.
In particular, lesions that compress the anterior spinal cord, such as ossification of posterior longitudinal ligament, can exacerbate myelopathy during surgery, therefore, endoscopic thoracic spine surgery is a very dangerous and difficult, and open surgery should be actively considered if there is insufficient experience.
In lumbar endoscopic surgery, the full endoscopic interlaminar approach had a higher incidence of dural tear than the transforaminal approach, which might have been caused by medical instruments when dealing with the ligamentum flavum or adhered disc. According to our study, comparing the complications of the 2 methods, transforaminal approach had a high incidence of exiting nerve root injury, so dysesthesia was the most common, followed by untreated pain due to a high probability of incomplete surgery, and incidental dural tears which was less common. In contrast, the interlaminar approach requires decompression of nerves on both sides in the epidural space. The possibility of a dural tear and the incidence of epidural hematoma are high during instrument manipulation. The incidence of other complications was similar between the 2 methods.
Dura tear is the most frequently reported complication of endoscopic surgery in works of various literatures. Since nerve root herniation causes serious symptoms and secondary nerve damage, it is important to prevent nerve root herniation in dura defects. Until now, the gold standard treatment for dural damage is open dural repair, but recently, sealing dura defect by using TachoSil (collagen fleece) has been widely performed a lot in endoscopic surgery without open surgery requiring general anesthesia.
Hematoma is another common complication of the endoscopic spinal surgery. Intraoperative bleeding not only obstructs the surgical field of vision and delays the surgical time, but also can cause serious postoperative complications by unintentionally damaging structures during blind surgery. In general, electrical coagulation using radiofrequency is performed, however, it can be very difficult to control bleeding under a narrow endoscopic view.
In this case, it is easy to temporarily secure the surgical field using a hemostatic agent such as floseal, finding the bleeding site and cauterizing bleeding point. Even at the end of surgery, it is important to insert a hemostatic agent to prevent undetected bleeding during surgery. In patients with massive intraoperative bleeding or bleeding tendencies, it is important to insert a Hemovac to prevent hematoma so that unexpected bleeding is well drained and nerves are not compressed.
Nerve damage is a complication that occurs during surgery, and once it occurs, it cannot be treated surgically. Therefore, prevention is the most effective treatment option. In order to prevent this, accurate anatomical knowledge of endoscopic surgery and the safety of the approach must be considered, and careful and delicate surgery must be performed to avoid injury to the nerve during surgery.
Once nerve damage occurs, it takes a lot of time to recover even if it is reversible, and various treatments such as drug treatment and rehabilitation treatment must be performed because the symptoms vary depending on the degree and site of nerve damage.
Prevention is the best treatment for many other complications mentioned in this text. Even in a narrow space with a narrow field of view, it is necessary to obtain the same results as open surgery, therefore, a lot of experience and a long learning curve cannot be avoided.
In the last 5 years, many literatures related to endoscopic spinal surgery have been published. However, retrospective studies (level 3 evidence) are the mainstream, and level 1 evidence papers such as RCTs are absolutely lacking. In addition, there are many papers on full (uniportal) endoscopic spine surgery, however, papers on biportal endoscopic surgery are very rare, especially on the cervical and thoracic spine. For future endoscopic spinal surgery to have the same basis as open surgery, which is still the gold standard, more high-quality evidence such as RCT is needed. Based on these literatures, it is expected that meta-analyses on various topics will be conducted.
According to literature analysis, the endoscopic spinal surgery in lumbar, dura tear, postoperative hematoma, transient dysesthesia and untreated pain are relatively common. Additionally, various complications such as urinary retention, motor weakness, cauda equine syndrome, wound infection may occur. On the other hand, endoscopic cervical surgery, swallowing difficulty, hoarseness are common complication in anterior approach, dura tear, postoperative hematoma, transient dysesthesia and weakness are common in posterior approach. In summary, it is most important to understand the advantages and disadvantages of various endoscopic approach methods and to select the most effective and convenient surgical approach for the spinal disease.
The author has nothing to disclose.
This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Flow diagram (PRISMA format) of the screening and selection process of full endoscopic spinal surgery.
Complications of full endoscopic cervical surgery of reviewed study
Study | Year | Design | Country | Approach | Complications (n) |
---|---|---|---|---|---|
Guo et al. [ |
2022 | Systematic review meta-analysis | China | Full endoscopic | Total complication rate (4.7%), reoperation rate (1.1%) |
Choi et al. [ |
2017 | Systematic review | Korea | Full endoscopic | Neurological injury, vascular injury, visceral injury |
Quillo-Olvera et al. [ |
2018 | Technical review | Korea | Full endoscopic | Anterior PECD: vascular injury, hematoma, swallowing dysfunction, esophageal injury, nerve(spinal cord, dura) injury, infection |
Posteriro PECD: neck pain, nerve(spinal cord, dura) injury, bleeding, high pressure irrigation, hematoma, instability | |||||
Bucknall and Gibson. [ |
2018 | Systematic review | UK | Full endoscopic | Anterior PECD: numbness (8), recurrent laryngeal nerve injury (2), discitis (1), vascular injury (3), persistent pain (3), neck pain (14), hematoma (2), headache (2), swallowing dysfunction (2), etc. |
Posteriro PECD: transient dysesthesia (5), neck pain (2), nerve (spinal cord, dura) injury (8), infection (2) |
PECD, percutaneous endoscopic cervical discectomy.
Complications of full endoscopic anterior cervical surgery of reviewed study
Study | Year | Design | Country | Approach | Complications (n) |
---|---|---|---|---|---|
Ahn et al. [ |
2005 | Retrospective study | Italy | Full endoscopic | Swallowing difficulty (2) |
Ruetten et al. [ |
2009 | Prospective randomized controlled study | Germany | Full endoscopic | SwaIlowing difficulty (2), recurrent disc (2) |
Tzaan [ |
2011 | Retrospective study | Taiwan | Full endoscopic | Recurrent disc (2) |
Yang et al. [ |
2014 | Retrospective comparative cohort study | China | Full endoscopic | Hematoma (1), reoperation (1), headache (1) |
Parihar et al. [ |
2018 | Retrospective study | India | Full endoscopic | C5 nerve deficit (1), hoarseness (1), swallowing difficulty (2), hematoma (16), incomplete decomp (2) |
Tacconi and Giordan [ |
2019 | Prospective study with meta-analysis | Italy | Full endoscopic | Esophageal injury (1), C7 nerve deficit (1) |
Yu et al. [ |
2019 | Case series | China | Full endoscopic | mediastinal effusion (1), endplate collapse (2) |
Ramírez León et al. [ |
2020 | Retrospective study | USA | Full endoscopic | Hematoma (3), carotid lesion injury (2), dysphonia (3), reoperation (3) |
Ahn et al. [ |
2020 | Retrospective comparative cohort study | Korea | Full endoscopic | Swallowing difficulty (1), recurrent disc (2) |
Ren et al. [ |
2020 | Retrospective study | China | Full endoscopic | Td: Recurrent disc (2), Tc: mediastinal effusion (1), endplate collapse (2), headache (1), hematoma (1) |
Complications of full endoscopic posterior cervical surgery of reviewed study
Study | Year | Design | Country | Approach | Complications (n) |
---|---|---|---|---|---|
Ruetten et al. [ |
2008 | Prospective randomized controlled study | Germany | Full endoscopic | Transient hypesthesia (3), recurrence (3) |
Huang et al. [ |
2020 | Prospective cohort study | China | Full endoscopic | Dura rear (2), hypesthesia (2) |
Wu et al. [ |
2021 | Prospective study with Retrospective | Korea | Full endoscopic | Motor deficit (2), recurrence (1), neuropraxia(1) |
Yang et al. [ |
2014 | Retrospective comparative cohort study | China | Full endoscopic | Neurogic deficit (1), reoperaion (1) |
Shu et al. [ |
2019 | Retrospective systematic review | China | Full endoscopic | Upper limb weakness (1) |
Lee et al. [ |
2018 | Retrospective systematic review | Korea | Full endoscopic | Motor weakness (mild 2, severe 1), dura tear (1), dysthesia (1), hematoma (1), recurrence (1) |
Zheng et al. [ |
2018 | Retrospective systematic review | China | Full endoscopic | Hematoma (1), reop. persistent pain (2), dura injury (1) |
Tong et al. [ |
2020 | Retrospective comparative study | China | Full endoscopic | Nerve root injury (2) |
Xiao et al. [ |
2019 | Retrospective comparative study | China | Full endoscopic | Pain (2), numbness (3), weakness (1) |
Wang et al. [ |
2021 | Retrospective comparative study | China | Full endoscopic | Pain (1), dura injury (3), C5 palsy (4) |
Yu et al. [ |
2021 | Retrospective comparative study | China | Full endoscopic | Dura injury (1) |
Ma et al. [ |
2020 | Retrospective comparative study | China | Full endoscopic | Key hole: pain (1). Dura injury (2), weakness (1), disc recur (1) |
Delta: pain (1), numbness (1), disc recurred (1) | |||||
Ma et al. [ |
2022 | Retrospective comparative study | China | Full endoscopic | Hematoma (1), dural injury(1) |
Ye et al. [ |
2017 | Retrospective study | China | Full endoscopic | Transient hypesthesia (1) |
Yu et al. [ |
2019 | Retrospective study | China | Full endoscopic | Arm pain (1) |
Kim et al. [ |
2009 | Retrospective study | Korea | Full endoscopic | Arm pain (1) |
Zhong et al. [ |
2022 | Retrospective study | Korea | Full endoscopic | Arm pain (1) |
Liu et al. [ |
2021 | Retrospective study | Italy | Full endoscopic | Transient hypesthesia (1) |
Dalgic et al. [ |
2022 | Case series | Turkey | Full endoscopic | Pain (1), dura injury (3), disc recurred (1) |
Complications of biportal endoscopic posterior cervical surgery of reviewed study
Study | Year | Design | Country | Approach | Complications (n) |
---|---|---|---|---|---|
Jung and Kim [ |
2022 | Retrospective study | Korea | Biportal endoscopic | Transient motor weakness (1) |
Zhu et al. [ |
2022 | Technical note | China | Biportal endoscopic | Transient hypesthesia (1) |
Kim et al. [ |
2022 | Technical note | Korea | Biportal endoscopic | Operation site pain and numbness (1) |
Song and Lee [ |
2020 | Technical note | Korea | Biportal endoscopic | Dura tear (1) |
Complications of full endoscopic thoracic surgery of reviewed study
Study | Year | Design | Country | Approach | Complications (n) |
---|---|---|---|---|---|
Ruetten et al. [ |
2018 | Retrospective comparative study | Germany | Full endoscopic transforaminal | Interlaminar: hematoma (1), transient dysesthesia (1) |
Extraforaminal: dura tear (1), hematoma (1), intercostal neuralgia (2), myelopathy (1) | |||||
Transthoracic retropleural: dura tear (1), transient dysesthesia (1), myelopathy (1) | |||||
Total: 19% | |||||
Gibson et al. [ |
2021 | Retrospective study | UK | Full endoscopic interlaminar | Dura tear (11; 2%), transient paresthesia (10; 2%), revision (7; 1.5%), neurologica injury (3; 0.6%), hematoma (3; 0.6%) |
Complications of full endoscopic transforaminal thoracic surgery of reviewed study
Study | Year | Design | Country | Approach | Complications (n) |
---|---|---|---|---|---|
Nie and Liu [ |
2013 | Retrospective study | China | Full endoscopic transforaminal | Spinal positional headache (1), recurrence (1) |
Choi et al. [ |
2017 | Review | Korea | Full endoscopic transforaminal | Neurological injury, vascular injury, visceral injury |
Ruetten et al. [ |
2018 | Retrospective study | Germany | Full endoscopic transforaminal | Myelopathy (1) |
Choi and Munoz-Suarez [ |
2020 | Review and technical note | Korea | Full endoscopic transforaminal | Dura tear, nerve injury, vascular, pulmonary injury, incomplete decompression, heat injury, infection |
Bae et al. [ |
2020 | Retrospective comparative cohort study | Korea | Full endoscopic transforaminal | Transient motor weakness (1), paresethesia (3), recurrence (2) |
Lin et al. [ |
2020 | Retrospective study | China | Full endoscopic transforaminal | Transient intercostal neuralgia (1) |
Bae et al. [ |
2020 | Retrospective comparative study | Korea | Full endoscopic transforaminal | Incomplete Decompression (1) |
Complications of full endoscopic interlaminar thoracic surgery of reviewed study
Study | Year | Design | Country | Approach | Complications (n) |
---|---|---|---|---|---|
Cheng and Chen [ |
2020 | Retrospective study | China | Full endoscopic transforaminal | Dura tear (1), Transient paralysis (1) |
Jho [ |
2020 | Retrospective study | USA | Full endoscopic transforaminal | Recurrence (1), no pain relief (3) |
Lin et al. [ |
2021 | Retrospective study | China | Full endoscopic transforaminal | Hematoma (1) |
Complications of full endoscopic lumbar decompression of reviewed study
Study | Year | Design | Country | Approach | Complications (n) |
---|---|---|---|---|---|
Sairyo et al. [ |
2010 | Retrospective review | Japan | Full endoscopic | Dural tear (6), Hematoma (2), nerve injury (1), fracture (1) |
Müller et al. [ |
2018 | Systematic review | USA | Full endoscopic | Dural tear (3.7%) |
Kim et al. [ |
2020 | Retrospective study | Korea | Full endoscopic interlaminar | Dural tear (8.2%) |
Nam et al. [ |
2013 | Case series | Korea | Full endoscopic interlaminar | Dural tear (3) |
Youn et al. [ |
2020 | Case report | Korea | Full endoscopic transforaminal | Epidural lipomatosis (1) |
Complications of full endoscopic transforminal decompression of reviewed study
Study | Year | Design | Country | Approach | Complications (n) |
---|---|---|---|---|---|
Kambin et al. [ |
1996 | Prospective study | USA | Full endoscopic transforaminal | Dyseshesia (4), infection (1) |
Knight et al. [ |
2014 | Prospective study | UK | Full endoscopic transforaminal | Recurrent transient predominant symptom (15) |
Li et al. [ |
2019 | Comparative study | China | Full endoscopic transforaminal | Dysesthesia (1), nerve injury (1), revision operation (2) |
Tang et al. [ |
2018 | Retrospective study | China | Full endoscopic transforaminal | Dysesthesia (1), temporary pain aggravation (6), neck pain (1) |
Zhang et al. [ |
2020 | Retrospective study | China | Full endoscopic transforaminal | Dysesthesia (3), dural tear (2) |
Lewandrowski [ |
2014 | Retrospective study | USA | Full endoscopic transforaminal | None |
Wen et al. [ |
2016 | Retrospective study | China | Full endoscopic transforaminal | Recurred pain (reop) (5), dural tear (1) |
Lewandrowski [ |
2018 | Retrospective study | USA | Full endoscopic transforaminal | Irritation of dorsal root ganglion (12) |
Lewandrowski [ |
2018 | Retrospective study | USA | Full endoscopic transforaminal | Dysesthesia (9), incisional pain (5), infection (2) |
Yang et al. [ |
2019 | Retrospective study | China | Full endoscopic transforaminal | Dysesthesia (4), dural tear (1), urinary retention (1) |
Youn et al. [ |
2019 | Retrospective study | Korea | Full endoscopic transforaminal | Dyseshesia (5) |
Yeung et al. [ |
2019 | Retrospective study | China | Full endoscopic transforaminal | Dysesthesia (9), hematoma (1), other level pain (2), persistent pain (3), disc herniation (9) |
Bao et al. [ |
2019 | Retrospective study | China | Full endoscopic transforaminal | Transient recurrence of symptoms (4), reoperation (2) |
Lewandrowski [ |
2019 | Retrospective study | USA | Full endoscopic transforaminal | Durotomy (2), foot drop (2), disc reherniation (9), wound infection (1), discitis (1), COPD (1) |
Li et al. [ |
2020 | Retrospective study | China | Full endoscopic transforaminal | Dural tearing (3), temporary leg numbness (5) |
Martínez et al. [ |
2020 | Retrospective study | USA | Full endoscopic transforaminal | None |
Lewandrowski and Ransom [ |
2019 | Retrospective study | USA | Full endoscopic transforaminal | Dysesthesia (8), untreated pain (reop) (32) |
Song et al. [ |
2021 | Retrospective study | China | Full endoscopic transforaminal | Dysesthesia (1), incomplete decompression (reop) (1) |
Liu et al. [ |
2020 | Retrospective study | China | Full endoscopic transforaminal | None |
Yeung and Lewandrowski [ |
2020 | Retrospective study | USA | Full endoscopic transforaminal | Dysesthesia (17), recurrent HNP (9), hematoma (1), untreated pain (37) |
Zhang et al. [ |
2020 | Retrospective study | China | Full endoscopic transforaminal | Dysesthesia (1), temporary pain aggravation (2) |
Cheng et al. [ |
2020 | Retrospective study | China | Full endoscopic transforaminal | Dural tear (1), untreated pain (reop) (1), tibialis anterior weakness (1) |
Nam et al. [ |
2020 | Case report | Korea | Full endoscopic transforaminal | Fracture (1) |
Ahn et al. [ |
2003 | Technical note | Korea | Full endoscopic transforaminal | Missed foraminal dis fragment (reop) (1) |
COPD, chronic obstructive pulmomary disease; HNP, herniation nucleus pulposus.
Complications of full endoscopic interlaminar lumbar decompression of reviewed study
Study | Year | Design | Country | Approach | Complications (n) |
---|---|---|---|---|---|
Ruetten et al. [ |
2009 | RCT | Germany | Full endoscopic interlaminar | Dural tear (1), dysesthesia (3), urinary retention (1) |
Komp et al. [ |
2011 | Prospective study | Germany | Full endoscopic interlaminar | Dural tear (2), dysesthesia (5), urinary retention (2), foot dorsiflexion paresis (1) |
Komp et al. [ |
2015 | RCT | Germany | Full endoscopic interlaminar | Dural tear (2), dysesthesia (4), motor weakness (1), urinary retention (1) |
Kamson et al. [ |
2017 | Retrospective study | USA | Full endoscopic interlaminar | Reoperation (reherniation) (3), sympathetical pain (2), urinary retention (1) |
Hwang et al. [ |
2017 | Case series | Korea | Full endoscopic interlaminar | Hematoma |
Lee et al. [ |
2018 | Retrospective study | Korea | Full endoscopic interlaminar | Dural tear (6), dysesthesia (12), nerve injury (3) disc herniation (2) |
Kim et al. [ |
2017 | Retrospective study | Korea | Full endoscopic interlaminar | Dural tear (3), untreated pain(reop) (2) |
Kim et al. [ |
2017 | Retrospective study | Korea | Full endoscopic interlaminar | Dural tear (1), untreated pain(reop) (2) |
Lee et al. [ |
2018 | Meta-analysis | Korea | Full endoscopic interlaminar | Dysesthesia (4), dural tear (5), hematoma (3), headache (3), reoperation (7) |
Park and Lee [ |
2019 | Retrospective study | Korea | Full endoscopic interlaminar | None |
Li et al. [ |
2019 | Comparative study | China | Full endoscopic interlaminar | Dyseshesia (2) |
Lim et al. [ |
2019 | Retrospective study | Korea | Full endoscopic interlaminar | Dural tear (7), hematoma (5), infection (1), untreated pain (reop) (6) |
Lee et al. [ |
2018 | Retrospective study | Korea | Full endoscopic interlaminar | Dural tear (6), dysesthesia (12), nerve injury (3) disc herniation (2) |
Cao et al. [ |
2019 | Retrospective study | China | Full endoscopic interlaminar | Untreated pain (3), spinal cord hypertension (1) |
McGrath et al. [ |
2019 | Retrospective study | USA | Full endoscopic interlaminar | Dyseshesia (3), disc herniation (1) |
Huang et al. [ |
2019 | Retrospective study | Korea | Full endoscopic interlaminar | Dural tear (1), untreated pain (reop) (11 (2)) |
Hua et al. [ |
2020 | Retrospective study | China | Full endoscopic interlaminar | Dural tear (2), cauda equina syndrome (1) |
Chiu et al. [ |
2020 | Retrospective study | China | Full endoscopic interlaminar | Medical problem (2) |
Yang et al. [ |
2020 | Retrospective study | China | Full endoscopic interlaminar | Dural tear (2), medical problem (2), urinary retention (2) |
Lim et al. [ |
2020 | Retrospective study | Korea | Full endoscopic interlaminar | Dural tear (5), hematoma (1), dysesthesia (8), untreated pain (reop) (1) |
Ruetten et al. [ |
2020 | Systematic review | Germany | Full endoscopic interlaminar | Wrong level surgery, epidural bleeding, insufficient decompression, dural tear, nerve injury, vessels injury gans |
Zhao et al. [ |
2019 | Retrospective study | China | Full endoscopic interlaminar | Dural tear (1), Dysesthesia (2), untreated pain (reop) (1) |
Yoshikane et al. [ |
2021 | Retrospective study | Japan | Full endoscopic interlaminar | Dural tear (4), hematoma (3), untreated pain (reop) (2) |
Yoshikane et al. [ |
2021 | Retrospective study | Japan | Full endoscopic interlaminar | Dural tear (5), hematoma (1), motor weakness (6) |