Percutaneous endoscopic lumbar discectomy for lateral disc herniation

English Keywords:Lumbar disc herniation  Endoscope  Lateral disc herniation  Posterolateral approach

English Abstract:

  【Abstract】 Objective：To evaluate the efficacy and surgical technique of percutaneous endoscopic lumbar discectomy（PELD） for lateral disc herniation.Method：Forty patients with lateral disc herniation were subjected to percutaneous endoscopic lumbar discectomy from March 2006 to December 2006.There were 25 males and 15 females with the average age of 35 years（range，17-63 years）.Surgical segments included L5/S1 in 8 cases，L4/5 in 30 cases，L3/4 in 2 cases.All patients were performed under local anesthesia with 1% lidocaine and bupivacaine infiltration.C-arm was used for percutaneous placement of posterolateral needle.After placing the work tube and exposure of herniated nucleus pulposus，the extruded nucleus fragments were pulled through the endoscopic working channel.The modified MacNab criteria and visual analogue scale（VAS） were employed to evaluate the clinical outcome.Result：There were no dural matter tear and intraoperative neurovascular injury.Five patients suffered transient hyperalgia in lower limbs which healed after 1 week of conservative treatment.The mean follow-up period was 12 months.The average operative time was 70 minutes per level.The blood loss was 5-20ml.The bed time was 24-48 hours（average，36h）.The average hospital stay was 5 days（range，3-10 days）.The VAS scores of sciatica decreased from 8.5±1.2 of preoperative to 3.5±1.4 at 3th days postoperative and 1.5±1.1 at 12th months postoperative（P<0.01）.There were 30 excellent，6 good and 4 fair according to MacNab score system with the excellent to good rate of 90%.Conclusion：PELD is applicable for lateral disc herniation，which has the advantages of minimally invasive and early function recovery.