Percutaneous Endoscopic Transforaminal Lumbar Discectomy: A Critical Appraisal

Abstract

Percutaneous endoscopic transforaminal lumbar discectomy (PETD) is one of the surgical techniques for the treatment of the lumbar disc herniations. Fenestration of the annulus and partial resection of the nuclear substance are achieved percutaneously by a posterolateral approach under local anaesthesia. The results of the first 42 patients are evaluated regarding the learning curve and indications for this procedure. The mean follow-up time was 15 months. Excellent and good results were evaluated as successful and the overall success rate is 77 %. All six patients with foraminal disc herniations in whom a free fragment could be removed had excellent results. Military personnel can return to work quickly without deficits with the use of this technique.

Percutaneous discectomy - minimal invasive spine surgery - herniated disc - learning curve

References

• 1 Dandy W E. Loose cartilage from intervertebral disk simulating tumor of the spinal cord.  Arch Surg. 1929;  19 660-672
• 2 Mixter W J, Barr J S. Rupture of intervertebral disc with involvement of the spinal canal.  N Engl J Med. 1934;  211 210-215
• 3 Caspar W, Iwa H. A microsurgical operation for lumbar disc herniations.  Neurol Surg (Tokyo). 1979;  6 657-662
• 4 Williams R W. Microlumbar discectomy: A conservative surgical approach to the virgin herniated lumbar disc.  Spine. 1978;  3 175-182
• 5 Yaşargil M G. Microsurgical operation for herniated disc. In: Wullenweber R, Brock M, Hamer J, Klinger M, Spoerri O (eds), Advances in Neurosurgery. Berlin: Springer-Verlag 1977: pp 81-82
• 6 Hijakata S, Yamgishi M, Nakayama T, Oomori K. Percutaneous discectomy: a new treatment method for lumbar disc herniation.  J Toden Hosp. 1975;  5 5-13
• 7 Kambin P, Gellman H. Percutaneous lateral discectomy of the lumbar spine.  Clin Orthop. 1983;  174 127-132
• 8 Mayer H M, Brock M. Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy.  J Neurosurg. 1993;  78 216-225
• 9 Kambin P. Arthroscopic microdiscectomy.  Arthroscopy. 1992;  8 287-295
• 10 Dittsworth D A. Endoscopic transforaminal discectomy and reconfiguration: A posterolateral approach into the spinal canal.  Surg Neurol. 1998;  49 588-598
• 11 Suezawa Y, Schreiber A. Komplexe Indikationen in der Chirurgie des lumbalen Spinalkanals.  Z Orthop. 1987;  125 308-319
• 12 Choy D SJ, Ascher P W, Saddekni S, Alkaitis D, Lieber W, Hughes J, Diwan S, Altman P. Percutaneous laser disc decompressions: a new therapeutic modality.  Spine. 1992;  17 949-956
• 13 Maroon J C, Holst R A, Osgood C P. Chemopapain in the treatment of ruptured lumbar discs: Preliminary experience in 48 patients.  J Neurol Neuosurg Psychiatry. 1976;  39 508-513
• 14 Mayer H M, Brock M. Percutaneous endoscopic lumbar discectomy (PELD).  Neurosurg Rev. 1993;  16 115-120
• 15 Schreiber A, Leu H. Percutaneous nucleotomy: Technique with discoscopy.  Orthopedics. 1991;  14 439-444
• 16 Maroon J C. Current concepts in minimally invasive discectomy.  Neurosurgery. 2002;  51 (Suppl 2) 137-145
• 17 Smith M W, Foley K T. Microendoscopic discectomy: The first 100 cases. Presented at the Annual Meeting of the Congress of Neurological Surgeons, Seattle, WA October, 1998
• 18 Hermantin F U, Peters T, Quartararo L, Kambin P. A prospective randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy.  J Bone Joint Surg [Am]. 1999;  81 958-965
• 19 Kahanovitz N, Viola K, Goldstein T, Dawson E. A multicenter analysis of percutaneous discectomy.  Spine. 1990;  15 713-715
• 20 Revel M, Payan C, Valee C, Laredo J D, Lassale B. et al . Automated percutaneous lumbar discectomy versus chemonucleolysis in the treatment of sciatica: A randomized multicenter trial.  Spine. 1993;  18 1-7
• 21 Atlas S J, Chang Y, Kammann E, Deyo R A, Singer D E. Long-term disability and return to work among patients who have a herniated lumbar disc: the effect of disability compensation.  J Bone Joint Surg [Am]. 2000;  82 4-15
• 22 Atlas S J, Deyo R A, Keller R B. et al . The Maine Lumbar Spine Study. II. 1-Year outcomes of surgical and nonsurgical management of sciatica.  Spine. 1996;  21 1777-1786
• 23 Bozzao A, Gallucci M, Masciocchi C, Aprile I, Barile A, Passariello R. Lumbar disc herniation: MR imaging assessment of natural history in patients treated without surgery.  Radiology. 1992;  185 135-141
• 24 Coste J, Delecoeuillerie G, Cohen de Lara A, Le Marc J M, Paolaggi J B. Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice.  BMJ. 1994;  308 577-580
• 25 Croft P R, Macfarlane G J, Papageorgiou A C, Thomas E, Silman A J. Outcome of low back pain in general practice: a prospective study.  BMJ. 1998;  316 1356-1359
• 26 Delauche-Cavallier M-C, Budet C, Laredo J-D. Lumbar disc herniation: computed tomography scan changes after conservative treatment of nerve root compression.  Spine. 1992;  17 927-933
• 27 Weber H. Lumbar disc herniation: a controlled prospective study with 10 years of observation.  Spine. 1983;  8 131-140
• 28 Yasuma T, Makino E, Saito S, Inui M. Histological development of intervertebral disc herniation.  J Bone Joint Surg [Am]. 1986;  68 1066-1072
• 29 Deyo R A, Weinstein J N. Low back pain.  N Engl J Med. 2001;  344 363-370
• 30 Deburge A, Benoist M, Boyer D. The diagnosis of disc sequestration.  Spine. 1984;  9 496-501
• 31 Hijakata S. Percutaneous nucleotomy: a new concept technique and 12 years experience.  Clin Orthop. 1989;  238 9-23
• 32 Sachs B L, Vanharanta H, Spivey M A. et al . Dallas discogram description. a new classification of CT/discography in low-back disorders.  Spine. 1987;  12 287-294
• 33 Mathews H H. Transforaminal endoscopic microdiscectomy.  Neurosurg Clin North Am. 1996;  7 59-63
• 34 Nowitzke M A. Assessment of the learning curve for lumbar microendoscopic discectomy.  Neurosurgery. 2005;  56 755-762
• 35 Epstein N E. Surgically confirmed cauda equina and nerve root injury following percutaneous discectomy at an outside institution: a case report.  J Spinal Disord. 1990;  3 380-382
• 36 Hopper K, Sherman J L, Luethke J M, Ghaed N. The retrorenal colon in the supine and prone patient.  Radiology. 1987;  162 443-446
• 37 Onik G, Maroon J C, Jackson R. Cauda equina syndrome secondary to an improperly placed nucleotome probe.  Neurosurgery. 1992;  30 412-415