Neurosurgery notes/Procedures/TL spine procedures/Lumbar discectomy

Lumbar discectomy

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TL spine procedures
 

Complications of Discectomy:

  • Damage to the cauda equina
    • Resulting in paralysis (the loss of use of the legs, loss of sensation and loss of control of the bladder and bowel).
    • Due to
      • Haematoma
      • Ischaemic stroke
    • 1/300
    • Comprising of
      • Complete weakness
      • Complete numbness
      • No bladder bowel or sexual function
  • Damage to a nerve root
    • Numbers
      • Primary cases >1/100 cases
      • Revision surgeries 10/100 cases.
    • Symptoms
      • Weakness
      • Numbness, tingling or hypersensitivity
  • Incidental durotomy
    • Numbers
      • New < 5/100 cases (3%)
      • Revision surgeries more common
    • Symptoms of CSF leak
      • Low pressure headaches
      • Meningitis (rare)
    • Risk of reoperation to repair CSF leak < 0.05%
  • Recurrent sciatica
    • Due to
      • Scarring
      • Recurrent disc
    • Numbers
      • 5/100 cases at any time from a few days to several years later)
  • Problems with positioning during the operation
    • Pressure problems
    • Skin and nerve injuries
    • Eye complications (blindness)
  • Infection
    • Superficial wound infections: 4/100 cases.
    • Deep wound infections: 1/100 cases.
  • Large vessel injury
    • 1/10000
  • Bleeding
  • DVT/PE
    • PE: <1/700 cases
  • Stroke, heart attack or other medical or anaesthetic problems
  • Death
    • Due to damage to major blood vessels or vital organs at the front of the spine,
      • 1/10,000 cases
    • General anaesthetic fatal complications
      • 1/250,000 cases
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