Affiliations: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
Correspondence:
[*]
Corresponding author: Shisheng He, Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai 200072, China. Tel.: +86 21 66307330; Fax: +86 21 66307046; E-mail:tjspinecenter@163.com
Note: [1] These authors contributed equally to this work.
Abstract: OBJECTIVE: To present a unique case of guide wire breakage as a
rare complication during posterolateral endoscopic lumbar discectomy. BACKGROUND: Posterolateral endoscopic lumbar discectomy (PELD) has
become a routinely performed minimally invasive spinal procedure. However,
several complications of PELD have attracted our concerns, including the
intraoperative injury to neural and vascular structures and failure of the
surgery. We have countered a rare intraoperative complication of guidewire
breakage during a PELD procedure, as far as we know, this has not been
reported previously, and we wish to draw attention to this hazard. METHODS: The medical records, operative reports, and radiographical
imaging studies of a single patient were retrospectively reviewed. RESULTS: A 28-year-old man presented with right posterior sciatica
for 3 months was admitted to the hospital. Unsatisfactory improvement was
observed under supervised conservative treatment. Preoperative magnetic
resonance imaging (MRI) showed a disc herniation at the L4-L5 level. After
preoperative evaluation, a PELD procedure was performed with local
anesthesia. After advancement of guide wire and discography, the guiding rod
was found not in the vicinity of the extruding disc fragment. Therefore, the
operator tried to redirect the guiding rod. However, after several attempts,
the guide wire was broken in the disc fragment under imaging. With the
patient's permit, the operator inserted the working cannula to the broken
end of guide wire and retrieved it using straightened grasping forceps. Then
foraminotomy and fragmentectomy were accomplished under endoscope. The
patient made uneventful recovery and was free of symptoms for the following
6 months. CONCLUSIONS: In conclusion, the guide wire breakage during PELD
procedures is a rare but a serious complication. An appropriate manner and
operation is very important to prevent this complication. Once it does
occur, the remnant of the guide wire can possibly be retrieved under
endoscope with great experience. However, as for the beginners, a transfer
to open operation is suggested to prevent new complications.
Keywords: Endoscopic discectomy, case report, intraoperative complication, instrument breakage, working zone, minimally invasive surgery
