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Pooled analysis of unsuccessful percutaneous biportal endoscopic surgery outcomes from a multi-institutional retrospective cohort of 797 cases

  • Original Article - Spine degenerative
  • Published:
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Abstract

Background

Spinal percutaneous biportal endoscopic surgery (PBES) is a minimally invasive surgery; however, it is associated with several poor outcomes. This study aimed to analyze unsuccessful PBES outcomes and verify their relationships with patient satisfaction.

Methods

From May 2015 to June 2018, PBES was performed at several institutions. Unsuccessful outcomes (reoperation and prolonged hospital stay) due to various reasons (hematoma, lesion recurrence, incomplete decompression, dural tear, instability, ascites, and infection) were analyzed. To verify the relationships between surgical experience and unsuccessful outcomes, the first 50 cases and the later cases were compared. Logistic regression was used to assess the relationships between unsuccessful outcomes and patient dissatisfaction.

Results

Among 866 patients, 797 cases with 1-year follow-up and complete data were analyzed. In total, 82 patients with unsuccessful outcomes were identified (10.29%). The incidences of hematoma (p < 0.04), incomplete operation (p < 0.01), and dural tear (p < 0.01) were significantly higher in the first 50 cases than in the later cases. Analyses of the relationship between unsuccessful outcomes and patient dissatisfaction showed that incomplete decompression (odds ratio (OR) 4.06), postoperative instability (OR 3.64), hematoma (OR 3.25), ascite (OR 3.25), dural tear (OR 3.02), and local recurrence (OR 2.45, 95%) contributed significantly.

Conclusions

Unsuccessful PBES outcomes were mostly associated with hematomas, incomplete decompression, and dural tears; instability, ascites, and infection contributed to a lesser extent. Incomplete decompression, instability, hematoma, ascite, dural tear, and local recurrence were significantly related to patient dissatisfaction. The potential for poor outcomes should be described to the patient and considered prior to surgery.

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Abbreviations

CLA:

contralateral approach

CT:

computed tomography

CSF:

cerebrospinal fluid

FLA:

far lateral approach

IPA:

ipsilateral approach

MRI:

magnetic resonance imaging

ODI:

Oswestry Disability Index

OR:

odds ratio

PBES:

percutaneous biportal endoscopic surgery

POD:

postoperative day

VAS:

visual analogue scale

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Author information

Authors and Affiliations

  1. Department of Spine Center, Orthopaedic Surgery, Daechan Hospital, Incheon, South Korea

    Wanseok Kim & Sangho Han

  2. Himchan UHS Spine and Joint Centre, Neurosurgery, University Hospital Sharjah, Sharjah, United Arab Emirates

    Seung-Kook Kim

  3. Joint and Arthritis Research, Orthopaedic Surgery, Himchan Hospital, Seoul, South Korea

    Seung-Kook Kim

  4. Department of Pharmaceutical Medicine and Regulatory Sciences, College of Medicine and Pharmacy, Yonsei University, Seoul, South Korea

    Seung-Kook Kim & Su-chan Lee

  5. Department of Spine Center, Orthopaedic Surgery, Leaders Hospital, Seoul, South Korea

    Sang-Soo Kang

  6. Department of Spine Center, Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea

    Hyun-Jin Park

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  1. Wanseok Kim
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Contributions

SKK had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. WSK designed the study protocol. SSK and HJP managed the literature searches, summarized previous related work, and wrote the first draft of the manuscript. SHH and SCL provided revision for intellectual content and final approval of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Seung-Kook Kim.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of an appropriate institutional review board (IRB 169684–01–201,906-03) and with the 1964 Helsinki declaration and its later amendments.

Informed consent

For this type of study, formal consent was not required. However, informed consent was obtained from all patients.

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Kim, W., Kim, SK., Kang, SS. et al. Pooled analysis of unsuccessful percutaneous biportal endoscopic surgery outcomes from a multi-institutional retrospective cohort of 797 cases. Acta Neurochir 162, 279–287 (2020). https://doi.org/10.1007/s00701-019-04162-2

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  • DOI: https://doi.org/10.1007/s00701-019-04162-2

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