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. 2017 Jan-Feb;51(1):36-42.
doi: 10.4103/0019-5413.197520.

Percutaneous endoscopic lumbar discectomy: Results of first 100 cases

Kanthila Mahesha  1
Affiliations

Percutaneous endoscopic lumbar discectomy: Results of first 100 cases

Kanthila Mahesha. Indian J Orthop. 2017 Jan-Feb.

Abstract

Background: Lumbar disc herniation is a major cause of back pain and sciatica. The surgical management of lumbar disc prolapse has evolved from exploratory laminectomy to percutaneous endoscopic discectomy. Percutaneous endoscopic discectomy is the least invasive procedure for lumbar disc prolapse. The aim of this study was to analyze the clinical outcome, quality of life, neurologic function, and complications.

Materials and methods: One hundred patients with lumbar disc prolapse who were treated with percutaneous endoscopic discectomy from May 2012 to January 2014 were included in this retrospective study. Clinical followup was done at 1 month, 3 months, 6 months, 1 year, and at yearly interval thereafter. The outcome was assessed using modified Macnab's criteria, visual analog scale, and Oswestry Disability Index.

Results: The mean followup period was 2 years (range 18 months - 3 years). Transforaminal approach was used in 84 patients, interlaminar approach in seven patients, and combined approach in nine patients. An excellent outcome was noted in ninety patients, good outcome in six patients, fair result in two patients, and poor result in two patients. Minor complications were seen in three patients, and two patients had recurrent disc prolapse. Mean hospital stay was 1.6 days.

Conclusions: Percutaneous endoscopic lumbar discectomy is a safe and effective procedure in lumbar disc prolapse. It has the advantage that it can be performed on a day care basis under local anesthesia with shorter length of hospitalization and early return to work thus improving the quality of life earlier. The low complication rate makes it the future of disc surgery. Transforaminal approach alone is sufficient in majority of cases, although 16% of cases required either percutaneous interlaminar approach or combined approach. The procedure definitely has a learning curve, but it is acceptable with adequate preparations.

Keywords: Disc; Endoscopic discectomy; endoscopy; herniated; lumbar disc; lumbar discectomy; lumbar vertebrae; minimally invasive surgical procedure; percutaneous discectomy; transforaminal discectomy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Endoscopic view showing insertion of needle in AP view
Figure 2
Figure 2
Endoscopic view showing insertion of needle in lateral view
Figure 3
Figure 3
Endoscopic view showing endoscope and disc forceps in the disc space
Figure 4
Figure 4
Peroperative photograph showing removal of extruded disc fragment
Figure 5
Figure 5
(a) Preoperative magnetic resonance imaging T2WI mid sagittal section showing large disc at L4 L5 level (b) Preoperative magnetic resonance imaging T2WI axial section showing large central disc
Figure 6
Figure 6
(a) Postoperative magnetic resonance imaging T2WI sagittal section showing decompression at L4 L5 level (b) Postoperative magnetic resonance imaging T2WI axial section showing decompression
See this image and copyright information in PMC

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