Percutaneous lumbar discectomy. Review of 100 patients and current practice

In a prospective study, 100 patients with 102 herniations of the nucleus pulposus at L2-L3, L3-L4, L4-L5, and L5-S1 and unremitting radicular pain were treated by percutaneous lumbar discectomy. Ninety-three patients were available for follow-up examination. Three patients had died, and four patients could not be located for this review, but all had been followed for more than one year postoperatively and were judged to have had an excellent result at the time of the last follow-up examination. Fifty-nine patients have been followed for longer than two years postoperatively, with a maximum follow-up period of six years. Evaluations were based on modified MacNab criteria and patient interview, questionnaire, and examination. Eighty-one patients (87%) were judged to be successes, since they were pain-free and had returned to gainful employment and their preinjury activity levels. Twelve patients' operations (13%) were judged to be failures and required repeat surgical procedures at the level of the presenting pathologic condition. Three patients (not included in the follow-up group) died of unrelated causes; they had been followed for a minimum of 15 months postoperatively and were previously judged to have had an excellent result. No major complications, including superficial or deep infections, discitis, or neurovascular compromise, were encountered. Meticulous selection of patients for percutaneous lumbar discectomy is the key to success with the method.