Guide wire breakage during posterolateral endoscopic lumbar discectomy procedure: A case report.

OBJECTIVE: To present a unique case of guide wire breakage as a rare complication during posterolateral endoscopic lumbar discectomy.

BACKGROUND: Posterolateral endoscopic lumbar discectomy (PELD) has become a routinely performed minimally invasive spinal procedure. However, several complications of PELD have attracted our concerns, including the intraoperative injury to neural and vascular structures and failure of the surgery. We have countered a rare intraoperative complication of guidewire breakage during a PELD procedure, as far as we know, this has not been reported previously, and we wish to draw attention to this hazard.

METHODS: The medical records, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed.

RESULTS: A 28-year-old man presented with right posterior sciatica for 3 months was admitted to the hospital. Unsatisfactory improvement was observed under supervised conservative treatment. Preoperative magnetic resonance imaging (MRI) showed a disc herniation at the L4-L5 level. After preoperative evaluation, a PELD procedure was performed with local anesthesia. After advancement of guide wire and discography, the guiding rod was found not in the vicinity of the extruding disc fragment. Therefore, the operator tried to redirect the guiding rod. However, after several attempts, the guide wire was broken in the disc fragment under imaging. With the patient's permit, the operator inserted the working cannula to the broken end of guide wire and retrieved it using straightened grasping forceps. Then foraminotomy and fragmentectomy were accomplished under endoscope. The patient made uneventful recovery and was free of symptoms for the following 6 months.

CONCLUSIONS: In conclusion, the guide wire breakage during PELD procedures is a rare but a serious complication. An appropriate manner and operation is very important to prevent this complication. Once it does occur, the remnant of the guide wire can possibly be retrieved under endoscope with great experience. However, as for the beginners, a transfer to open operation is suggested to prevent new complications.