J Korean Soc Spine Surg.  2008 Dec;15(4):250-256. 10.4184/jkss.2008.15.4.250.

Percutaneous Endoscopic Lumbar Discectomy (PELD) Using Interlaminar Approach in Lumbar Disc Herniation: Endoscopic Laminotomy

• Kim EH
• Rhyu KH
• Kim CK

• KMID: 2209628
• DOI: http://doi.org/10.4184/jkss.2008.15.4.250

Abstract

STUDY DESIGN: Retrospective study
OBJECTIVES
This study examined the post-operative results of interlaminar percutaneous endoscopic lumbar discectomy (PELD) with or without endoscopic laminotomy in lumbar disc herniation. SUMMARY OF LITERATURE REVIEW: In addition to the technical feasibility, the indications of PELD surgery are usually the same as those for open discectomy.
MATERIALS AND METHODS
From January 2005 to August 2006, 62 cases treated with PELD using an interlaminar approach due to lumbar disc herniation were examined. The mean age of the subjects was 40.1 years (18-70) and the mean follow up period was 32.6 months (24-44). Thirty-four and 28 herniated discs were extracted from L4-L5 and L5-S1, respectively. The clinical results were evaluated using MacNab's criteria.
RESULTS
The herniated discs were accessible in all cases. Excellent and good results were obtained in 85% (53 cases) of patients but 15% of patients (9 cases) showed unsatisfactory results or needed revision. There were 4 cases of incomplete removal, 2 cases of recurrence and 4 cases of persistent low back pain due to associated degenerative pathologies. Additional surgery was required in 7 cases which were open discectomy in 5 cases (3 cases of 4 incomplete removal and 2 of recurrence). There was one case of PLIF and 1 additional decompression. Cauda equina syndrome occurred in one case who underwent subsequent wide decompression and open discectomy.
CONCLUSIONS
interlaminar PELD using endoscopic laminotomy is an effective method for treating lumbar disc herniation with moderate up and down migration. The clinical success rate can be improved by selecting patients with accessible discs and excluding those with an associated pathology.

Keyword

Lumbar disc herniation; Percutaneous endoscopic discectomy; Interlaminar approach; Endoscopic laminotomy

MeSH Terms

Decompression
Diskectomy
Follow-Up Studies
Humans
Intervertebral Disc Displacement
Laminectomy
Low Back Pain
Polyradiculopathy
Recurrence
Retrospective Studies

Figure

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  Fig. 1. 2.5 mm chisel and osteotome for endoscopic laminotomy.

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  Fig. 2. L5-S1 disc herniation with advanced disc degeneration and modic stage 1 change. This patient complaint of persistant back pain after PELD.

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  Fig. 3. (A) Central disc herniation at L5-S1. (B) cauda equine syndrome developed after PELD due to excessive traction and protrusion of incompletely removed disc.

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