Prevention of Complications

Abstract

With the development of spinal endoscopic surgery, cervical decompression and discectomy has become the major endoscopic cervical spine surgery. The lack of clear anatomical landmarks and hindered visualization of anatomical structures due to narrow operating view are significant limitations in the endoscopic approach to the spine. Complications during the learning curve period of endoscopic spine surgery usually occur due to unfamiliarity with endoscopic image orientation and inappropriate approach to the surgical target. This can result in injury to neural structures, incomplete decompression, dural tear, wrong-level procedures, and excessive removal of facet joint in the initial series of patients. The learning curve is steep because endoscopic drilling is performed close to neural structures. To avoid complications associated with endoscopic spine surgery, various factors should be considered. The important step for obtaining a good surgical outcome after endoscopic spine surgery is an ideal entry point and trajectory during the surgical approach. To prevent insufficient decompression, the widest decompression as possible is often required. However, excessive facet joint removal and surgically induced instability could lead to persistent symptoms, recurrent disc herniation, and progressive neck pain. Prevention of postoperative dysesthesia is also an important factor for successful cervical endoscopic decompression. The surgeon is responsible for optimal outcomes, which could affect the frequency and severity of adverse events. Endoscopic cervical spine surgery should be performed carefully using an appropriate surgical technique with sufficient experience.