Abstract

Purpose The object of this study was to introduce the transforaminal Percutaneous Endoscopic Lumbar Discectomy (PELD) and retroperitoneal laparoscopic (retro-peritoneoscopic) lateral approach. Techniques and to assess the safety and efficacy of treating patients with far-lateral and foraminal disc herniations via a percutaneous transforaminal endoscopic approach. The incidence of a lumbar disc herniation lateral to the facet has been reported to be between 0.7 and 11.7% over all sites of a lumbar disc herniation. Methods From May 1997 to December 2007 we operated 39cases of PED (20cases) and 10- syringe discectomy (16) and retroperitoneal laparoscopic lateral approach (3) for far lateral and foraminal lumbar disc herniations. A retrospective analysis was performed of 39 consecutive patients who underwent surgery via this approach. All procedures were performed after induction of a local anesthetic on an outpatient basis. Surgical indication was intractable leg pain regardless of symptom period, which was resistant to conservative treatment including selective root block. Results Outcome was measured with Macnab criteria and by determining a patient's return-to previous work. The median follow-up period was 15months (range 10-33 months). Excellent or good outcome was obtained in 31 (79.5%) of 39 patients. Of the 39patients playing sports and working before the onset of symptoms, 32 (82.1%) returned to previous work and sports. One patient (2.5%) experienced poor outcomes and subsequently underwent open procedures at the same level. There were no complications. Conclusions RLLA 10-syringe discectomy provide adequate exposure necessary for extra-foraminal exploration, discectomy and nerve root decompression. PELD is sufficient for minimally invasive treatment of extreme lateral lumbar herniation.