Percutaneous endoscopic lumbar discectomy: minimally invasive, but perhaps only minimally useful?

BACKGROUND A few recent studies dampen the euphoric reports of the value of percutaneous endoscopic lumbar discectomy (PELD) in the treatment of discogenic disease. We felt that a large-scale comparison between PELD and the still minimally invasive open lumbar disk surgery (OLDS) was called for. METHODS This report is based on the surgical experience of one year (1991) and is confined to the intervertebral disk level L4-5. Three hundred thirteen patients treated by open disk surgery were compared with 13 who were selected for percutaneous discectomy. RESULTS Using careful selection criteria, only 13 (4%) of a possible 326 were considered potentially suitable for PELD. Of these, only eight were wholly suitable and were operated on percutaneously. Within the first postoperative month, 62.5% (5 patients) of the PELD group required open surgery for definitive treatment, whereas only 14 (4%) of the 313 OLDS patients had to undergo additional surgery. CONCLUSIONS Although it may of benefit to a very few, we feel that the PELD method cannot be considered a substitute for, or even an alternative to, traditional surgery in most cases.