Innovation Method for Sealing Bone Bleeding in Percutaneous Endoscopic Interlaminar Discectomy

Abstract

Background: Adequate hemostasis to prevent postoperative epidural hematoma and its consequences such as cauda equina syndrome is important in lumbar spine surgery. However, in percutaneous endoscopic interlaminar discectomy (PEID), due to its tiny incision wound only allows for endoscopy and its sheath entered, adequate hemostasis could be difficult. Herein, we proposed an innovation way of applying bone wax to stop bone bleeding in PEID. Materials and Methods: A working channel with a beveled opening was introduced over the dilator and a rigid endoscope was inserted after the removal of the obturator. Endopunch was used to cut the ligamnetum flavum to expose underlying dura margin and nerve root. To avoid overtraction of the nerve root, we use an endoscopic high speed burr or endoscopic kerrison punch to remove partial medial facet and inferior margin of lamina to gain more room for instrument inside. Some bone bleeding causing unclear vision occurred as we proceeded. We thus use endoscopic nerve retractor to push the bone wax to the surface of the bone to seal the bleeding. Results: Intraoperative adequate hemostasis was achieved with clear endoscopic vision after the bone wax sealed the bleeding site. Conclusion: Using an endoscopic nerve retractor with bone wax to stop bone bleeding in percutaneous endoscopic interlaminar discectomy is an efficient way to provides us with immediate clear vision during the surgery.