LAUSR

OBJECTIVE To describe the perioperative clinical features, management, and outcomes of patients with seizure following percutaneous endoscopic spine surgery (PESS). METHODS Patients who experienced seizure following PESS in an tertiary orthopaedic hospital between January 2016 and June 2022 were retrospectively recruited, and patient charts were reviewed. RESULTS Twenty-nine patients were recruited, and the incidence of seizure following PESS was 0.52%. The operation time was 82.5 (110.0, 235.0) minutes and the irrigation speed was 86.5 (109.0, 145.5) mL/min. Definitive dural tears were reported in 15 patients (51.7%). In addition to agitation and myotonia, significant increased respiratory rate (29.9 ± 6.5 breaths /min), tachycardia (112.1 ± 20.6 beats /min), and hypertension (systolic, 189.5 ± 21.9 mmHg; diastolic, 98.3 ± 10.6 mmHg) were observed. Arterial blood gas analysis revealed hypocapnia, metabolic acidosis and hyperlactatemia. All patients received analgesia and sedation as well as hyperosmolar therapy. The estimated duration of seizure was 3.0 (2.5, 4.0) hours and the postoperative length of stay was 3.0 (3.0, 5.5) days. The Japanese Orthopaedic Association score and Visual Analogue Scale score improved markedly within 6 months after surgery. CONCLUSIONS Despite the low incidence and short duration, seizure following PESS should be considered a critical and urgent syndrome. Management strategies for seizure mainly involve intensive care, securing the airway, analgesia and sedation, hyperosmolar therapy and negative fluid balance. No significant adverse effects of seizure on clinical outcomes were observed during 6 months of follow-up.