• LianSong Lu, ZhenShan Yuan, HaoJie Li, and ShaoHua Sun.
• Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo City, Zhejiang Province, China. Electronic address: zhunhuanzj27477@163.com.
• Clinics (Sao Paulo). 2024 Jan 1; 79: 100498100498.

ObjectiveTo investigate the reasons for a second surgery after Percutaneous Endoscopic Surgery (PES) for lumbar spinal stenosis and to provide references for the choice of indications and appropriate surgical approach.MethodA total of 426 patients received PES for lumbar spinal stenosis. The postoperative, intraoperative, and postoperative data of the subjects were analyzed. The reasons for intraoperative difficulties, poor outcomes after surgery, and a second surgery were analyzed.ResultThe surgical approach was changed in four out of 426 patients (0.94 %) during surgery, and 6 patients (1.4 %) received a second surgery; 3 out of 4 patients were intraoperatively shifted to PIED using the Delta endoscope, and 1 shifted to ordinary PIED. The reasons for the intraoperative change of surgical approach included severe hyperplasia and obscure anatomic structure in 3 patients and a dural sac tear with neural outflow in 1 patient. The reasons for a second surgery in 19 patients were as follows: nerve entrapment by bone fragments in 1 patient; nerve injury in 3 patients; lumbar instability in 3 patients; untreated or residual Lumbar Intervertebral Disc Herniation (LIDH) in 4 patients; recurrent LIDH in 1 patient; and inadequate decompression in 7 patients.ConclusionSevere hyperplasia, obscure anatomic structure, lumbar instability, and nerve injury are the common reasons for a second surgery after PES for lumbar spinal stenosis. Appropriate indications and surgical approaches can be chosen based on the patient's situations and technical conditions.Copyright © 2024 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.

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