Abstract

Objective: Percutaneous Endoscopic Lumbar Discectomy (PELD) is an overnight stay operation that makes a 7 mm incision under local anesthesia. We discuss about the indications and results of transforaminal (TF), interlaminar (IL) and extraforaminal (EF) approach. Materials and methods: The TF approach was used in 241 cases in L2/3 ~ L5/S1, IL was 129 in only L5/S1 and EF was 52. Total cases were 422 composed of 320 males and 102 females, their average age 45.9. Patients with upward and downward migrations of 10 mm or more, instability found, any lateral recess less than 3 mm, or osseous proliferation of spondylolysis were excluded from the subjects. Results: JOA (Japanese Orthopaedic Association) scores before operation and 1 month, 3 months, and 6 months later were 11.0 (N=365), 20.0 (N=290), 22.1 (N=183), and 22.3 (N=113), respectively. The VAS (visual analogue scales) for buttock and lower limb were 7.1, 2.4, 1.8, and 1.5, respectively. Open surgery was performed in two cases with canal stenosis. 11remnants and 6 impossible insertion cases were operated on by MED, 12 recurrences and 1 level mistook case were operated on by the same methods, 2 instabilities were operated on by fusion. One root damage caused a drop foot, 15 pain residual cases were under self-control. Conclusion: PELD has indications for a large majority of lumbar disc herniation not complicated by bone lesions and is a minimally invasive spine surgery which allows the patient to walk and leave the next morning.