Failure Cause Analysis of Percutaneous Endoscopic Lumbar Discectomy

Abstract：Objective To analyze the failure cause analysis of percutaneous endoscopic lumbar discectomy (PELD). Methods From February 2010 to February 2014,421 patients had undergone PELD.The operation time,length of stay,postoperative complications,clinical outcomes (using modified Macnab criteria),failure rate of PELD and rate of recurrence were collected.Results The follow-up time was 12~56 months with a mean of 31 .6 months.Operative time was 30~100 mins a mean of 58.4 mins;hospitalization time was 2~5 days a mean of 3.4 days;the rate of good-to-ex-cellent was 90.3%;the failure rate of PELD was 4.3% (18/421);the rate of recurrence was 0.7% (3/421).The reasons of failure showed as following:incomplete removal of herniated disc material in 12 patients (66.7%),recurrence in 3 (16.7%)patients,postoperative persistent pain in 2 patients (11.1%),nerve root injury in 1 patient (5.6%).The rea-sons of incomplete removal of herniated disc material as following:technically inappropriate positioning of the working channel in 4 patients (33.3%),migrated discs herniation in 3 patients (25.0%),central disc in 3 patients (25.0%),axil-lary type in 3 patients (25.0%),and shoulder type in 1 patient (8.3%).Two patients with persistent pain,the MRI and CT examination showeds that they were associated with lateral recess stenosis.Conclusion PELD can achieve a satis-factory clinical outcomes,however,successful PELD requires techniques to remove the herniated disc fragments in vari-ous types of disc herniations,the accumulation of surgical experience and precise placement of the working channel.