Percutaneous lumbar discectomy: indications and surgical results in 35 consecutive cases

Thirty-five patients (27 men and eight women) who met our criteria of case selection for percutaneous lumbar discectomy (PLD) were treated by this method during the period May 1992 to June 1993. Thirty-six spaces, including one man with double disc disease, were decompressed. Patients ranged in age from 14 to 64 years. All patients but one were followed up for a minimum of six months. The operative results, evaluated by a more objective functional grading system, revealed a short-term (two months) success rate of 83% and a mid-term (six months) success rate of 76%. This discrepancy resulted from two recurrences of sciatic symptoms. It indicates that the medical conditions of those who have received PLD are by no means static, but instead may fluctuate. The operative result was similar to that of open discectomy, averaging 81.1% in reported series. Our "functional grading system" reflects these fluctuations quantitatively. With respect to the operative success rate, there was a statistical difference between the very good, good and fair-poor indication groups of patients, as were categorized by our major criteria of indications that included three clinical manifestation criteria and the other three radiographic findings. This result emphasizes the critical role of case selection in the operative success rate. Complications consisted of one disc infection which cleared without sequelae. This study provides an objective means of selecting cases and evaluating surgical results which, in turn, makes the use of this procedure convincing and predictable.