Transdural rootlet herniation- An exceptional complication of full endoscopic lumbar discectomy: case reports and review of literature.

Abstract

Introduction: Endoscopic lumbar spine surgery has been regarded as a safe and minimally invasive procedure over the last decades. The incidence of dural tears in endoscopic spine surgery has been around 1.1%. Transdural nerve root herniation is a rare but severe complication if not treated early. We reviewed the literature related to our cases. A classification is proposed by the authors to categorize the cases into 4 types.

Case description: We present 5 cases of transdural nerve root herniations in endoscopic lumbar spine surgery. The five cases have been classified into four different types by their time of detection, neurological status, and associated complications. According to anatomical location, 3 cases were ventral, one was lateral, and one was dorsal. One case was detected intraoperatively, while four were detected after the patient showed symptoms postoperatively. 4 cases were operated with a transforaminal endoscopic approach, and 1 case was operated with an interlaminar full endoscopic approach. One patient presented late with a neurological deficit, whereas one patient presented with pseudomeningoceole and infection. All root herniation cases were treated with an open microscopic repair. All five patients improved symptomatically postoperatively with no further complications. The classification can help categorize the nerve root herniation type in correlation with clinical outcomes. These five cases are described in detail in the manuscript.

Conclusion: In our studies, we have given a classification for transdural nerve root herniation in endoscopic lumbar spine surgery. Clinical judgment and radiological evaluation in the postoperative period are vital in cases of unrecognized nerve root herniation. Early detection, repositioning of the nerve root inside the dura, and repair of the dura tear are the treatment of choice for better outcomes.