Posterior endoscopic discectomy for the treatment of lumbar disc herniation

The procedure of posterior endoscopic discectomy (PED) is an attempt to allow for a standard familiar microsurgical discectomy to be performed using standard microsurgical techniques via a minimally invasive approach. The aim of this study was to evaluate our results with PED for lumbar disc herniation and to assess the advantages, disadvantages and clinical outcomes of the technique. Between February 2002 and August 2004, 71 patients with a mean age of 44 years (range : 24 to 73) underwent PED. The operated disc levels were L5-S1 in 37 patients, L4-L5 in 26 patients and L3-L4 in 8 patients. Mean operative time was 84 min. (41-135 min.). All patients experienced substantial relief of their leg pain immediately after the operation, mobilised very early after recovery from the anaesthesia and were discharged home within 24 hours of surgery with only oral NSAID +/- myorelaxants. PED has advantages like better illumination, better magnification, and better visualisation through the rotation of the 25 degrees lens, minimal bone resection and minimal epidural fibrosis, less postoperative pain, better cosmesis, shorter hospitalisation, early mobilisation and shorter recovery. On the other hand, PED has a longer learning curve than open discectomy, the operative time is usually longer than with open procedures and bidimensional vision may cause loss of depth sensation, and it entails a longer anaesthesia time due to the preparation period of the system.