[Establishment of Endoscopic Spinal Neurosurgery and its Current Status]

Percutaneous endoscopic lumbar discectomy(PELD)has been used as a standard surgical technique for lumbar disc herniation at the Southern TOHOKU Healthcare Group since its introduction in 2009. We present our clinical experiences with PELD for 6 years and discuss the decision-making process for its surgical indication with a review of the pertinent literature. PELD can be performed under both local anesthesia and general anesthesia, and requires only a stab wound for surgery and 3 days of hospitalization. Our surgical results showed generally satisfactory outcomes; however, a salvage surgery was required for 10 of the 96 patients(10.4%)because of early recurrence, insufficient removal of the transligamentous disc fragment, and coexistent canal stenosis. Surgery was discontinued because of unbearable intraoperative pain in one patient each undergoing transforaminal approach and extraforaminal approach under local anesthesia. Although our experience is limited, PELD is considered a promising minimally invasive surgery for lumbar disc herniation. It is generally indicated for patients who are young, sports oriented, or extremely busy. Recurrent disc herniation after microdiscectomy, high risk for general anesthesia, and emergency are considered ideal indications for this technique. Since PELD is a newer technique with a high learning curve, further study, continuous training, and education are required before its widespread implementation. Careful selection of patients is crucial to achieve satisfactory surgical results.