2017 Volume 26 Issue 5 Pages 346-352
Microsurgical discectomy is the gold standard treatment for the herniated nucleus pulposus (HNP) of the lumbar spine. On the other hand, less invasive procedures have been developed and accepted rapidly. Percutaneous endoscopic lumbar discectomy (PELD) was developed as one of the minimally invasive techniques for HNP of the lumbar spine, and it was introduced to the Southern TOHOKU Healthcare Group in 2009. Herein we present our clinical experiences with PELD, and its surgical indications and current limitations are also discussed, reviewing the pertinent literature. PELD is usually carried out under local anesthesia, requiring only a stab wound for operation. Hospitalization may not be required, but in our practice, patients are advised to stay in the hospital at least for one day after the operation. A total of 71 patients were treated with PELD to date, and our surgical results have generally been satisfactory, except for 2 procedures which were discontinued due to the uncontrollable pain, and salvage operations were required in 9 of the 69 patients (13.0%) because of early recurrence, insufficient removal of the transligamentous disc fragment, and coexistent canal stenosis. These unfavorable events occurred in our earlier cases, and we no longer experience them recently. Although our experience is limited, PELD is a promising minimally invasive surgery for lumbar disc herniation. Recurrent disc herniation after microdiscectomy, high risk for general anesthesia, disc herniation at the L3-4 level or above, and emergency cases are considered to be the most ideal indications for this technique. On the contrary, patients with poor accessibility to the disc space or bony canal stenosis, large and hard HNP, or HNP with an up- or downward migration of more than 10 mm of the disc level, should be excluded from the surgical indication. Since PELD is a newer technique, continuous training and education are required for widespread implementation. Careful selection of the patients is crucial to achieve satisfactory surgical results, and certain criteria should be established.
