Review of safety in endoscopic laser foraminoplasty for the management of back pain

Objective: The purpose of this study was to analyze the incidence and gravi ty of reported complications that arise in spinal surgery and assess the co mparative safety, or otherwise, of endoscopic laser foraminoplasty (ELF). B ackground Data: Chemonucleolysis, decompression, discectomy, and fusion hav e long been cited as treatments for chronic low back pain. Over recent year s newer, less invasive surgical techniques have become available, one such being ELF. Although minimally invasive, the beneficial outcome must be inte rpreted in relation to concerns regarding the safety of the procedure and i ts risks relative to those of other forms of spinal surgery. The Spinal Fou ndation, Rochdale has performed 958 ELFs and has collated a comprehensive d atabase of the results of all these operations. These prospective records p rovided the basis for a comparison of the safety of ELF to that reported wi th other spinal surgical techniques. Methods: A total of 958 procedures hav e been performed on 716 patients. Complications that arose during the opera tion and the postoperative phase of 6 weeks following the procedure were el icited from patient records. These data were correlated and compared to a m eta-analysis of randomized controlled clinical trial data of complications arising during and after conventional spinal surgery. The SPSS (statistical package for social sciences) and CIA (confidence interval analysis) statis tical packages were used to draw conclusions regarding the safety of ELF. R esults: The cohort integrity of operation and outpatient review records at 6 weeks after surgery was 100%, In 958 ELFs performed, 24 complications occ urred in 23 patients. There were 9 cases of discitis (1 infective, 8 asepti c) (0.9%), 1 dural tear (0.1%), 1 deep wound infection (0.1%), 2 patients s uffered a foot drop (1 transient) (0.2%), 1 myocardial infarction (0.1%), 1 erectile dysfunction (0.1%), and 1 patient who developed panic attacks pos t-operatively (0.1%), This amounts to an overall surgical complication rate of 1.6%, Magnetic resonance imaging (MRI) follow up of clinically symptoma tic patients highlighted 8 residual disc herniations (0.8%), Meta-analysis of randomized controlled trials of conventional spinal surgery for adult on set degenerative disc disease and/or sciatic pain reported overall complica tion rates for fusion (11.8%), decompression (7.6%), discectomy (6.0%), and chemonucleolysis (9.6%). Conclusions: The complication rate of ELF is show n to be significantly lower than that reported following conventional spina l surgery (p < 0.01). From these results, we conclude that ELF as a treatme nt for chronic low back pain and sciatica presents less risk to a patient t han conventional methods of spinal surgery.