J Minim Invasive Spine Surg Tech.  2020 Oct;5(2):88-91. 10.21182/jmisst.2020.00157.

Unrecognized Dural Tear During Transforaminal Percutaneous Endoscopic Lumbar Discectomy

• Choi SY
• Ahn Y

• KMID: 2562071
• DOI: http://doi.org/10.21182/jmisst.2020.00157

Abstract

As transforaminal percutaneous endoscopic lumbar discectomy (PELD) becomes more aggressively implemented, the risk for dural tears may increase and lead to severe neurological sequelae. Diagnostic and management strategies for these situations, however, have not been established. This report describes an unrecognized dural tear during transforaminal PELD. A 38‐year‐old woman sustained an unrecognized dural tear during transforaminal PELD at the L4‐5 level. Postoperative radicular symptoms were initially misdiagnosed as recurrent lumbar disc herniation. Despite revision PELD, symptoms were not resolved. The patient underwent endoscopic exploration at the authors’ clinic to examine the cause of radicular pain, which revealed a small dural tear and nerve root entrapment at the lateral aspect of the dura. Open repair using interbody fusion was performed at the L4‐5 level. The dural tear was primarily closed and the pinched nerve root was relieved. The patient’s pain symptoms improved, and she was discharged after adequate wound care. Although PELD is an effective and safe minimally invasive technique, incidental dural tears can occur. Surgeons should be aware of the risks for dural damage and have comprehensive knowledge of clinical features. Early diagnosis with a high level of suspicion is essential to preventing long‐term neurological sequelae.

Keyword

Discectomy; Dural tear; Endoscopic; Percutaneous; Transforaminal