Percutaneous lumbar discectomy with a working endoscope and laser assistance

The authors describe percutaneous disc surgery performed via the unilateral monoportal method with a C-arm image intensifier, a working endoscope, and an yttrium-aluminum-garnet laser in 300 patients at three community hospitals over a 6-year period. Visualizing the area of the annulus to be fenestrated, verifying the status of the nerve root, inspecting the cavity created, and monitoring laser hemostasis and vaporization all contributed to patient safety. Fewer than 2% of the cases required a second surgery. The only postoperative sequelae recorded were one psoas hematoma, which resolved, and sympathetic mediated pain in 5% of the patients who responded to appropriate treatment. For treatment of a prolapsed lumbar disc, a 1-hour endoscopic procedure performed while the patient receives a neuroleptanalgesic continues to be a significant surgical alternative.