10 October 2024 : Review article
Comprehensive Analysis of UBE-Related Complications: Prevention and Management Strategies from 4685 Patients
Lili Yang1AE, Tong Yu1ABC, Jianhang Jiao1BF, Tingting Hou1FG, Yang Wang1BF, Bin Zhao1CD, Minfei Wu1CE, Weibo Jiang1AEF*DOI: 10.12659/MSM.944018
Med Sci Monit 2024; 30:e944018
Table 2 The types, causes, and treatment options of UBE complications reported in the literature.
| Complications types | References | Morbidity (%) | Causes | Treatment options |
|---|---|---|---|---|
| Incidental dural tear | []20 | 2/65 (3.1) | NR | Conservative management |
| Incidental dural tear | []10 | 3/72 (4.2) | NR | 3 patients were observed with a dural tear in the ULIF group; the tear was covered with a dural patch instead of a primary repair |
| Incidental dural tear | []28 | 7/67 (13.2) | NR | Fibrin seal patch, conversion to microscopic surgery, revision for duroplasty |
| Incidental dural tear | []23 | 18/797 (2.3) | NR | Reoperation in 3, conserve treatment in 15 |
| Incidental dural tear | []29 | 5/5 (100) | NR | Nonpenetrating titanium vascular anastomosis clips |
| Incidental dural tear | []25 | 12/165 (7.27) | Incidental thecal sac lesion during durotomy | Bed rest in 5fibrin sealant in 5the endoscopic suture in 2 |
| Incidental dural tear | []26 | 25/1511 (1.6) | Injury of central dural folding during flavectomy under turbid surgical fields due to small bleeds under water. | Gelform, fibrin glue, open repair, TachoSil, blood patch, endoscopic clipping, or observation |
| Incidental dural tear | []30 | 2/29 (7) | NR | NR |
| Incidental dural tear | []27 | 29/643 (4.5) | NR | 12 were treated with in hospital monitoring and bed rest14 were treated with a fibrin sealant2 were treated with a nonpenetrating titanium clip1 was converted to microscopic surgery |
| Incidental dural tear | []23 | 18/797 (2.3) | NR | Reoperation in 3, conserve treatment in 15 |
| Incidental dural tear | []31 | 2/21 (9.5) | NR | Conservative treatment |
| Incidental dural tear | []3 | 1/106 (0.9) | NR | Without open repair |
| Incidental dural tear | []9 | 2/42 (4.8) | NR | TachoSil (Nycomed, Linz, Austria) |
| Incidental dural tear | []32 | 2/105 (1.9) | NR | Conservative treatment |
| Incidental dural tear | []33 | 3/71 (4.2) | NR | Fibrin collagen patch (TachoComb) combined with lumbar drain for 5 to 7 days |
| Incidental dural tear | []15 | 3/43 (7) | NR | The external pressure applied by the pump irrigation acted as a tamponade against CSF leak; the tear was sealed within 5 min with a small bleb. |
| Incidental dural tear | []34 | 2/55 (3.6) | NR | Bed rest |
| Pseudomeningocele | []35 | 1/1 (100) | Dural tear occurred during the laminotomy procedure using an osteotome | Fibrin sealant patch was used to cover the dural tear via UBE |
| Incidental dural tear | []41 | 1/14 (7.1) | NR | Conservative treatment |
| Foot drop | []28 | 1/67 (1.5) | Dural tear | Reoperation |
| L5 root palsy | []41 | 1/14 (7.1) | NR | Follow up treatment in the outpatient clinic |
| Numbness of the contralateral leg | []51 | 2/11 (18.2) | Incomplete removal of the ruptured disc on the contralateral side | NR |
| Incomplete decompression | []23 | 18/797 (2.3) | Experience factors | Conservative treatment (including medication and epidural steroid injection) |
| Incomplete decompression | []3 | 1/106 (0.9) | NR | Reoperation |
| Incomplete decompression | []49 | 3/60 (5) | The ruptured disc fragment was incompletely removed | Conversion to OLM |
| Headache | []34 | 2/55 (3.6) | NR | Bed rest |
| Headache | []28 | 1/67 (1.5) | Dural tear, CSF leak | Reoperation |
| Epidural hematoma | []44 | 94/310 (30.3) | NR | Conservative treatment or reoperation |
| Epidural hematoma | []33 | 1/71 (1.4) | NR | NR |
| Epidural hematoma | []47 | 43/206 (20.9) | NR | Gelatin-thrombin matrix sealant |
| Epidural hematoma | []32 | 1/105 (1) | NR | Reoperation |
| Epidural hematoma | []20 | 3/65 (4.6) | NR | Conservative management |
| Epidural hematoma | []23 | 18/797 (2.3) | Experience factors | NR |
| Symptomatic hematoma | []30 | 1/29 (3) | NR | Reoperation |
| Epidural hematoma and neurological symptoms | []34 | 1/55 (1.8) | NR | Hematoma evacuation was performed using the UBE technique |
| Anemia | []61 | 42/136 | Hidden blood loss | Adequate assessment of risk factors for hidden blood loss in the perioperative period. For details of risk factors, please see reference []61 |
| Hydroperitoneum | []23 | 4/797 (0.5) | NR | Extended in-hospital monitoring and intermittent fluid drainage |
| Hydroperitoneum | []57 | 1/44 (2.3) | If orientation were lost without scoping upward from the L5 transverse process and going straight down under the level of the L5 transverse process, the psoas muscle layer could be penetrated and infused saline could make hydroperitoneum | Sono-guided paracentesis was performed to treat and aspirated the infused saline |
| Back pain | []15 | 1/43 (2.3) | Poor patient selection | Posterior instrumentation and fusion |
| Delayed wound healing | []3 | 2/106 (1.8) | NR | Debridement |
| Infection | []23 | 1/797 (0.1) | NR | Remove the infected abscess by UBE, 3 weeks of hospitalization for the administration of intravenous antibiotics, and 3 weeks of oral antibiotics |
| Infection | []33 | 1/71 (1.4) | NR | NR |
| Recurrent disc herniation | []15 | 1/43 (2.3) | NR | Re-surgery by UBE |
| Recurrent disc herniation | []5 | 1/31 (3.2) | Spondylolytic spondylolisthesis preoperatively | Transforaminal interbody fusion via the UBE technique |
| Recurrent disc herniation | []23 | 18/797 (2.3) | Incomplete decompression | NR |
| Restenosis | []31 | 1/21 (5) | The worsening of the preoperatively known spondylolisthesis (2 mm) | NR |
| Reoperation | []25 | 7/165 (4.24) | NR | NR |
| Reoperation | []23 | 35/797 (4.4) | Hematoma, incidental dural tear, instability, infection, recurrence, incomplete operation | Decompression or fusion |
| Reoperation | []28 | 1/67 (1.5) | Dural tear, headache, CSF leak, foot drop | After the failure of the fibrin seal patch and lumbar drain, revision for duroplasty was carried out |
| Reoperation | []32 | 1/105 (1) | Epidural hematoma | UBE decompression |
| Reoperation | []44 | 6/310 (1.9) | Cauda equina syndrome or severe radiating pain after surgery | Symptomatic epidural hematoma evacuation |
| Instability | []23 | 5/797 (0.6) | NR | Additional fusion surgery in 2, conservative treatment in 3 |
| UBE – unilateral biportal endoscopic; NR – not reported; OLM – open lumbar microdiscectomy; CSF – cerebrospinal fluid. | ||||