Percutaneous discectomy

Method

The discectomy is performed through a cannula inserted through the back into the center of the vertebral disc under local anesthetic 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　has　slipped into the spinal channel can be removed with this minimally invasive method.

Advantages of PELD

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

PELD is indicated for all levels of disc prolapse, including L5/S1. Prolapsed and sequestrated discs can be safely treated with this technique. It is also indicated for lumbar canal stenosis 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 fearful of surgery and general anesthesia.

Fast mobilisation

Patients can leave the recovery room just two hours after the operation. They can travel home just one day after surgery, following checks from 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 Percutaneous Endoscopic Lumbar Discectomy (PELD) is a technically difficult procedure with a long learning curve for the surgeon, it has proven an effective, safe, and successful treatment of herniated discs, with a minimal complication rate.