Overview and Prevention of Complications During Full-Endoscopic Cervical Spine Surgery

Abstract

Objective: Posterior full-endoscopic cervical foraminotomy/discectomy (PECF) is used to treat medically intractable cervical radiculopathy. PECF has many potential advantages; however, despite its minimally invasive nature, complications of PECF are possible, including hemorrhage, infection, injury to neural tissue, damage to the facet joint and musculature, loss of cervical lordosis, and subsequent progression to cervical kyphosis. We examined complications following PECF and reviewed the relevant literature.Methods: We retrospectively reviewed 101 patients who underwent PECF for either disc herniation (DH, 59 patients) or foraminal stenosis (FS, 42 patients). After surgery, the patients were encouraged to ambulate and were discharged 2–3 days later without the use of a neck collar. Events occurring during hospitalization were documented in the hospital information system. Patients were followed-up for a mean period of 21±26 months (range, 1–110 months).Results: Clinical parameters improved from 1 month postoperatively and were maintained throughout the follow-up period, with no significant differences between the DH and FS groups (p>0.05). Complications occurred in 14 patients (14%) with no significant difference between the DH (8 of 59, 14%) and FS (6 of 42, 14%) groups (p>0.05). The most common complication was dural tear, followed by motor weakness, sensory changes, hematoma collection, incomplete decompression, reoperation, and wrong-level surgery. Two patients underwent reoperation due to symptomatic hematoma collection and symptom recurrence 3 years postoperatively.Conclusion: The incidence of complications following PECF was 14%. Although most were transient, an understanding of both reported and unreported complications, along with thorough preparation, could reduce the occurrence of PECF-associated complications.