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Minim Invasive Neurosurg 2006; 49(2): 74-79
DOI: 10.1055/s-2006-932184
Original Article
© Georg Thieme Verlag Stuttgart · New York

Percutaneous Endoscopic Transforaminal Lumbar Discectomy: A Critical Appraisal

A.  Kafadar1 , S.  Kahraman2 , M.  Akbörü3
  • 1Department of Neurosurgery, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
  • 2Department of Neurosurgery, GATA Medical Faculty, Ankara, Turkey
  • 3Etimesgut Airforce Hospital, Ankara, Turkey
Further Information

Publication History

Publication Date:
18 May 2006 (online)

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Abstract

Percutaneous endoscopic transforaminal lumbar discectomy (PETD) is one of the surgical techniques for the treatment of the lumbar disc herniations. Fenestration of the annulus and partial resection of the nuclear substance are achieved percutaneously by a posterolateral approach under local anaesthesia. The results of the first 42 patients are evaluated regarding the learning curve and indications for this procedure. The mean follow-up time was 15 months. Excellent and good results were evaluated as successful and the overall success rate is 77 %. All six patients with foraminal disc herniations in whom a free fragment could be removed had excellent results. Military personnel can return to work quickly without deficits with the use of this technique.

Key words

Percutaneous discectomy - minimal invasive spine surgery - herniated disc - learning curve

References

  • 1 Dandy W E. Loose cartilage from intervertebral disk simulating tumor of the spinal cord.  Arch Surg. 1929;  19 660-672
    PubMedGoogle Scholar
  • 2 Mixter W J, Barr J S. Rupture of intervertebral disc with involvement of the spinal canal.  N Engl J Med. 1934;  211 210-215
    CrossrefPubMedGoogle Scholar
  • 3 Caspar W, Iwa H. A microsurgical operation for lumbar disc herniations.  Neurol Surg (Tokyo). 1979;  6 657-662
    PubMedGoogle Scholar
  • 4 Williams R W. Microlumbar discectomy: A conservative surgical approach to the virgin herniated lumbar disc.  Spine. 1978;  3 175-182
    CrossrefPubMedGoogle Scholar
  • 5 Yaşargil M G. Microsurgical operation for herniated disc. In: Wullenweber R, Brock M, Hamer J, Klinger M, Spoerri O (eds), Advances in Neurosurgery. Berlin: Springer-Verlag 1977: pp 81-82
    Google Scholar
  • 6 Hijakata S, Yamgishi M, Nakayama T, Oomori K. Percutaneous discectomy: a new treatment method for lumbar disc herniation.  J Toden Hosp. 1975;  5 5-13
    PubMedGoogle Scholar
  • 7 Kambin P, Gellman H. Percutaneous lateral discectomy of the lumbar spine.  Clin Orthop. 1983;  174 127-132
    PubMedGoogle Scholar
  • 8 Mayer H M, Brock M. Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy.  J Neurosurg. 1993;  78 216-225
    CrossrefPubMedGoogle Scholar
  • 9 Kambin P. Arthroscopic microdiscectomy.  Arthroscopy. 1992;  8 287-295
    PubMedGoogle Scholar
  • 10 Dittsworth D A. Endoscopic transforaminal discectomy and reconfiguration: A posterolateral approach into the spinal canal.  Surg Neurol. 1998;  49 588-598
    CrossrefPubMedGoogle Scholar
  • 11 Suezawa Y, Schreiber A. Komplexe Indikationen in der Chirurgie des lumbalen Spinalkanals.  Z Orthop. 1987;  125 308-319
    PubMedGoogle Scholar
  • 12 Choy D SJ, Ascher P W, Saddekni S, Alkaitis D, Lieber W, Hughes J, Diwan S, Altman P. Percutaneous laser disc decompressions: a new therapeutic modality.  Spine. 1992;  17 949-956
    PubMedGoogle Scholar
  • 13 Maroon J C, Holst R A, Osgood C P. Chemopapain in the treatment of ruptured lumbar discs: Preliminary experience in 48 patients.  J Neurol Neuosurg Psychiatry. 1976;  39 508-513
    PubMedGoogle Scholar
  • 14 Mayer H M, Brock M. Percutaneous endoscopic lumbar discectomy (PELD).  Neurosurg Rev. 1993;  16 115-120
    CrossrefPubMedGoogle Scholar
  • 15 Schreiber A, Leu H. Percutaneous nucleotomy: Technique with discoscopy.  Orthopedics. 1991;  14 439-444
    PubMedGoogle Scholar
  • 16 Maroon J C. Current concepts in minimally invasive discectomy.  Neurosurgery. 2002;  51 (Suppl 2) 137-145
    PubMedGoogle Scholar
  • 17 Smith M W, Foley K T. Microendoscopic discectomy: The first 100 cases. Presented at the Annual Meeting of the Congress of Neurological Surgeons, Seattle, WA October, 1998
    Google Scholar
  • 18 Hermantin F U, Peters T, Quartararo L, Kambin P. A prospective randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy.  J Bone Joint Surg [Am]. 1999;  81 958-965
    PubMedGoogle Scholar
  • 19 Kahanovitz N, Viola K, Goldstein T, Dawson E. A multicenter analysis of percutaneous discectomy.  Spine. 1990;  15 713-715
    PubMedGoogle Scholar
  • 20 Revel M, Payan C, Valee C, Laredo J D, Lassale B. et al . Automated percutaneous lumbar discectomy versus chemonucleolysis in the treatment of sciatica: A randomized multicenter trial.  Spine. 1993;  18 1-7
    PubMedGoogle Scholar
  • 21 Atlas S J, Chang Y, Kammann E, Deyo R A, Singer D E. Long-term disability and return to work among patients who have a herniated lumbar disc: the effect of disability compensation.  J Bone Joint Surg [Am]. 2000;  82 4-15
    PubMedGoogle Scholar
  • 22 Atlas S J, Deyo R A, Keller R B. et al . The Maine Lumbar Spine Study. II. 1-Year outcomes of surgical and nonsurgical management of sciatica.  Spine. 1996;  21 1777-1786
    CrossrefPubMedGoogle Scholar
  • 23 Bozzao A, Gallucci M, Masciocchi C, Aprile I, Barile A, Passariello R. Lumbar disc herniation: MR imaging assessment of natural history in patients treated without surgery.  Radiology. 1992;  185 135-141
    CrossrefPubMedGoogle Scholar
  • 24 Coste J, Delecoeuillerie G, Cohen de Lara A, Le Marc J M, Paolaggi J B. Clinical course and prognostic factors in acute low back pain: an inception cohort study in primary care practice.  BMJ. 1994;  308 577-580
    PubMedGoogle Scholar
  • 25 Croft P R, Macfarlane G J, Papageorgiou A C, Thomas E, Silman A J. Outcome of low back pain in general practice: a prospective study.  BMJ. 1998;  316 1356-1359
    CrossrefPubMedGoogle Scholar
  • 26 Delauche-Cavallier M-C, Budet C, Laredo J-D. Lumbar disc herniation: computed tomography scan changes after conservative treatment of nerve root compression.  Spine. 1992;  17 927-933
    PubMedGoogle Scholar
  • 27 Weber H. Lumbar disc herniation: a controlled prospective study with 10 years of observation.  Spine. 1983;  8 131-140
    CrossrefPubMedGoogle Scholar
  • 28 Yasuma T, Makino E, Saito S, Inui M. Histological development of intervertebral disc herniation.  J Bone Joint Surg [Am]. 1986;  68 1066-1072
    PubMedGoogle Scholar
  • 29 Deyo R A, Weinstein J N. Low back pain.  N Engl J Med. 2001;  344 363-370
    CrossrefPubMedGoogle Scholar
  • 30 Deburge A, Benoist M, Boyer D. The diagnosis of disc sequestration.  Spine. 1984;  9 496-501
    PubMedGoogle Scholar
  • 31 Hijakata S. Percutaneous nucleotomy: a new concept technique and 12 years experience.  Clin Orthop. 1989;  238 9-23
    PubMedGoogle Scholar
  • 32 Sachs B L, Vanharanta H, Spivey M A. et al . Dallas discogram description. a new classification of CT/discography in low-back disorders.  Spine. 1987;  12 287-294
    PubMedGoogle Scholar
  • 33 Mathews H H. Transforaminal endoscopic microdiscectomy.  Neurosurg Clin North Am. 1996;  7 59-63
    PubMedGoogle Scholar
  • 34 Nowitzke M A. Assessment of the learning curve for lumbar microendoscopic discectomy.  Neurosurgery. 2005;  56 755-762
    CrossrefPubMedGoogle Scholar
  • 35 Epstein N E. Surgically confirmed cauda equina and nerve root injury following percutaneous discectomy at an outside institution: a case report.  J Spinal Disord. 1990;  3 380-382
    PubMedGoogle Scholar
  • 36 Hopper K, Sherman J L, Luethke J M, Ghaed N. The retrorenal colon in the supine and prone patient.  Radiology. 1987;  162 443-446
    CrossrefPubMedGoogle Scholar
  • 37 Onik G, Maroon J C, Jackson R. Cauda equina syndrome secondary to an improperly placed nucleotome probe.  Neurosurgery. 1992;  30 412-415
    PubMedGoogle Scholar

Ali Kafadar, M. D. 

Insirah Sok. Kerem

Apt. No: 29 D: 9

34342 Bebek

Istanbul

Turkey ·

Phone: +90/532/324/0186

Fax: +90/212/230/0659

Email: kafadar@istanbul.edu.tr; kafideal@yahoo.com

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