[Limited indication for percutaneous lumbal nucleotomies.]

The aim of our retrospective study is to show how very circumspect we are to use this method. The clinical symptoms of our patients were lumbalgia or lumboischialgia with or without neurological deficiencies. All these patients were resistent to conservative therapies. We accepted for operation only patients who suffered from protrusions and types of prolaps without perforation of the posterior longitudinal ligament. 179 operations on the vertebral discs were performed in our department between 01. 01. 1992 until 31.12.1997. Of this number 165 (92 %) were conservative nucleotomies (63 females and 102 males) and 14 patients (8 %) hat percutane nucleotomies and discos-copies (6 females and 8 males). The average age at the time of operation was 49 years (from 12 to 81 years) with patients who had an open operation, whilst the patients who had percutane nucleotomy had an average age of 42 years (26 to 56 years). The time span between postoperative checkups was on average about 40 months (3 years and 4 months). The shortest postoperative checkup period was 2 months and the longest 71 months (5 years and 11 months). Of the 14 cases mentioned we operated 9 patients in the segment L4/5, 4 patients in the segment L5/S1 and one patient in the segment L3/4. In 7 instances it was the right side that was injured and 7 times it was the left side which was injured. We performed all operations under general anaesthesia, the patient lying prone on the abdomen with lumbal lordosis raised as much as possible. We always used an X-ray picture enlarger on two planes. As far as subjective pain is concerned, an analysis of the findings gives the following results: 100 % improvement 6 patients, 80 % improvement 2 patients, 50 % improvement 3 patients, no improvement 3 patients. Five praeoperative existing motorial deficiencies had completely vanished postoperatively. As to eventual complications, we had one patient suffering from a lesion at the root of L4 on the right side with postoperative Spondylodiscitis L3/4 who was treated in a conservative way. When patient selection for this method is critically considered, the advantage of endoscopic operation lies in minimal invasion and rapid rehabilitation is associated with it.