A percutaneous discectomy is a surgical procedure in which the central portion of an intervertebral disc

Intervertebral disc

Intervertebral discs lie between adjacent vertebrae in the spine. Each disc forms a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together.-Structure:...

 is accessed and removed through a cannula

Cannula

A cannula or canula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of data...

.

Method

The discectomy

Discectomy

A Discectomy is the surgical removal of herniated disc material that presses on a nerve root or the spinal cord. The procedure involves removing the central portion of an intervertebral disc, the nucleus pulposus, which causes pain by stressing the spinal cord or radiating nerves...

 is performed through a cannula

Cannula

A cannula or canula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of data...

 inserted through the back into the center of the vertebral disc under local anesthetic

Local anesthetic

A local anesthetic is a drug that causes reversible local anesthesia, generally for the aim of having local analgesic effect, that is, inducing absence of pain sensation, although other local senses are often affected as well...

 using a stylet. After the position of the stylet is confirmed to be correct using AP and Lateral X-ray views it is removed leaving the cannula in place. The disc material may be removed using surgical tools such as the Dekompressor or traditional manual surgical tools, however the manual instruments require a larger cannula and more disruption to the surrounding structures. Both the automated and manual percutaneous discectomy procedures produce similar results and reduction in disc height and pressure on the nerves to result in pain reduction.

Percutaneous Endoscopic Lumbar Discectomy

Percutaneous Endoscopic Lumbar Discectomy (PELD) is a step advance from lumbar microdiscectomy. PELD is a percutaneous surgical procedure for safe and sparing excision of herniated disc material. Even sequestered disc material - regardless of its size and level - that slipped into the spinal channel can be removed with the minimal invasive method.

Advantages of PELD

The PELD offers a number of advantages in comparison to conventional methods:

1. Immediate pain relief in 95 % of the cases - study info needed
2. Direct access to herniated disc/sequester
3. The disc-annulus and the ligament remain intact
4. No general anesthesia, only a sparing local anesthetic necessary
5. Outpatient treatment
6. Shorter rehabilitation -study info needed
7. Faster return to profession and everyday life - study info needed
8. Small incision (only one stitch) = hardly any scarring

Indications

The PELD is indicated for all levels of disc prolapse

Prolapse

Prolapse literally means "to fall out of place", from the Latin prolabi meaning "to fall out". In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is used for organs protruding through the vagina or the rectum or for the misalignment of the...

 even for L5/S1. Prolapsed and sequestrated discs can be safely treated with this technique. It is also indicated for lumbar canal stenosis

Stenosis

A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....

 where foraminoplasty is performed to decompress the nerve root. It is also suitable for elderly patients, patients with cardiovascular problems, pregnant patients, and patients who are afraid of surgery and general anesthesia.

Fast mobilisation

Patients can leave the recovery room singly just two hours after the operation. They can travel home just one day after the surgery, following a check up with their surgeon and physiotherapist. Light office work can be taken up within a week. Physical work and sports are allowed after 6 weeks.

Conclusion

Although the Percutaneous Endoscopic Lumbar Discectomy (PELD) is a technically difficult procedure with a long learning curve for the surgeon, it has proven as an effective, safe and successful treatment of the herniated disc with a minimal complication rate.