Unique Complications of Percutaneous Endoscopic
Lumbar Discectomy and Percutaneous Endoscopic
Interlaminar Discectomy
Authors: Xuexiao Ma 
Published: October 2019

Background: Percutaneous endoscopic discectomy (PED) includes 2 main procedures: percutaneous endoscopic
lumbar discectomy (PELD) and percutaneous endoscopic interlaminar discectomy (PEID), both of which are
minimally invasive surgical procedures that effectively deal with lumbar degenerative disorders. Because of the
challenging learning curve for the surgeon and the individual characteristics of each patient, preventing and
avoiding complications is difficult. The most common complications, such as nucleus pulposus omission, nerve
root injury, dural tear, visceral injury, nerve root induced hyperalgesia or burning-like nerve root pain, postoperative
dysesthesia, posterior neck pain, and surgical site infection, are difficult to avoid; however, more focus on these
issues perioperatively may be in order. Additionally, unique and unexpected complications can also occur, such as
retroperitoneal hematoma (RPH), intraoperative seizures, and thrombophlebitis, among others.
Objective: We aim to delineate unique complications during PED and accumulate strategies to prevent
significant morbidity and improve surgical techniques.
Study Design: A retrospective cohort study of patients undergoing PEID or PELD from October 2014
to January 2016.
Setting: Affiliated hospitals of Qingdao University.
Methods: Patients with lumbar disc herniation (LDH) who underwent PEID and PELD were retrospectively
analyzed. Complications were recorded and analyzed pre and postoperatively. We assessed clinical
outcomes using the visual analog scale (VAS) and Oswestry Disability Index (ODI) and classified the results
into “excellent,” “good,” “fair,” or “poor” based on the modified MacNab criteria. All of the patients
were followed for more than one year to evaluate their recovery from complications.
Results: From October 2014 to January 2016, 426 patients with LDH underwent PEID (106 cases) or PELD (320
cases). Common complications and occurrence rates were as follows: the incomplete removal of herniated discs
was 1.4% (6/426), recurrence 2.8% (12/426), nerve root injury 1.2% (5/426), dural tear 0.9% (4/426), and nerve
root induced hyperalgesia or burning-like nerve root pain 2.3% (10/426); no posterior neck pain or surgical site
infection occurred. Unique complications included: passage of the working channel through the spinal canal into
the disc space (one case), super-elastic nerve hook caught by exiting nerve root (one case), epidural hematoma (one
case), radicular artery injury and massive bleeding (one case) which was revised by micro-endoscopic discectomy,
and intraoperative seizure (one case). No serious consequences occurred after active medical intervention, and most
patients had good recovery by 3 months postoperatively with physical therapy.
Limitations: The main limitations of this study are the retrospective study design, limited case number,
and short follow-up period.
Conclusions: PEDs are effective and minimally invasive methods for the surgical treatment of LDH,
causing fewer complications due to the very minimal operational trauma for the muscle-ligament
complex and stability of the spine. Nevertheless, because of the difficult learning curve for surgeons,
lack of experience with the requisite surgical techniques, and enhanced clinical responsibility, a variety
of problems may occur. Especially concerning are the unique complications mentioned here, which
potentially lead to severe injury for the patient and require diligent preventive measures.
Key words: Unique complications, epidural, hematoma, interlaminar, transforaminal, PEID, PELD