A retrospective review involving 307 consecutive cases of lumbar disc herniation managed by posterolateral endoscopic discectomy was conducted.
To describe a contemporary posterolateral endoscopic decompression technique for radiculopathy secondary to lumbar disc herniation; to evaluate the efﬁ- cacy of the technique as it is applied to lumbar disc herniation including primary herniation, reherniation, intracanal herniation, and extracanal herniation; and to report outcome and complications.
The technique and equipment for performing posterolateral percutaneous endoscopic lumbar discectomy has evolved dramatically in the past five years. The current level of proficiency brings endoscopic capabilities close to the capabilites of conventional transcanal open operations. The foraminal approach can be used not only for herniated discs, but also for degenerative conditions of the lumbar spine.
The advantage of the foraminal endoscopic technique is the ability to reach, visualize, and treat certain intradiscal and foraminal pathologic lesions without destabilizing the posterior muscle column and facets. Intradiscal visualization is enhanced by chromo-discography combining non-ionic radiographic agents (isovue-300) with indigocarmine dye. This blue dye differentially stains degenerated nucleus.
The learning curve is steep, but once mastered, the surgeon is able to reach any pathologic lesion in the foramen, including noncontained disc herniations, foraminal stenosis, facet cysts, and annular tears.
Chronic lumbar discogenic pain (CLDP) impairs the patient’s physical abilities to function within the normal physiologic loading ranges of activities of daily living. The pathogenesis of CLDP is multi-factorial and not well understood. Conservative
therapeutic regimens often fail to achieve sufficient pain relief. Surgical options vary greatly in surgical invasiveness as well as outcome. Definitive surgical treatment is often 360° fusion. The morbidity associated with this approach is significant when considering only 65-80% of patients obtain satisfactory clinical results. This has spawned interest in minimally invasive surgical options like IDET, but results are conflicting.