Postoperative Management of Sequelae, Complications, and Readmissions Following Outpatient Transforaminal Lumbar Endoscopy

Abstract

Best management practices of complications resulting from outpatient transforaminal endoscopic decompression surgery for lumbar foraminal and lateral recess stenosis are not established. Recent advances in surgical techniques allow for endoscopically assisted bony decompression for neurogenic claudication symptoms due to spinal stenosis. These broadened indications also produced a higher incidence of postoperative complications ranging from dural tears, recurrent disc herniations, nerve root injuries, foot drop, facet and pedicle fractures, or infections. Postoperative sequelae such as dysesthetic leg pain, and infiltration of the surgical access and spinal canal with irrigation fluid causing spinal headaches and painful wound swelling, as well as failure to cure, are additional common postoperative problems that can lead to hospital readmissions and contribute to lower patient satisfaction with the procedure. In this chapter, the authors focus on analyzing the incidence of such problems and, more importantly, how to manage them. While the incidence of these problems is recogniz-ably low, knowing the art of managing them in the postoperative recovery period can make the difference between a flourishing endoscopic outpatient spinal surgery program and one that will continue to struggle with replacing traditional open spinal surgeries.