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Automated percutaneous lumbar discectomy: a prospective multi-institutional study
G J Teng1, R F Jeffery, J H Guo
1Department of Radiology, Nanjing Railway Medical College, China.
Summary
Automated percutaneous lumbar discectomy (APLD) using a new instrument achieved an 83% success rate at one year in over 1,500 patients. This minimally invasive procedure shows excellent results for various disc conditions and back pain.
Area of Science:
- Neurosurgery
- Minimally Invasive Spine Surgery
- Orthopedic Surgery
Background:
- Disc herniation and back pain are common conditions requiring effective treatment.
- Minimally invasive techniques are increasingly explored for spinal disorders.
Purpose of the Study:
- To evaluate the efficacy and safety of automated percutaneous lumbar discectomy (APLD) with a novel instrument.
- To assess APLD outcomes in a large patient cohort across multiple hospitals.
Main Methods:
- A prospective study involving 1,582 APLD procedures in 1,525 patients with disc herniation or back pain.
- Follow-up of at least 1 year was available for 1,474 patients, with a mean follow-up of 18.3 months.
- Procedures were performed using a straight needle with patients in the lateral decubitus position.
Main Results:
- An overall success rate of 83% was observed at 1 year, based on Hijikata's criteria.
- Higher success rates were noted for disc protrusion (86%) versus sequestration (72%), back pain alone (89%) versus mixed pain (80%), shorter symptom duration (<2 years), and younger patients (<60 years).
- A low complication rate of 0.06% (discitis) was reported, with 99% technical success at L5-S1.
Conclusions:
- Automated percutaneous lumbar discectomy (APLD) with the evaluated instrument demonstrates excellent clinical outcomes.
- The procedure is effective for patients with back pain alone, expanding its potential indications.
- Proper patient positioning allows for the use of a straight needle at L5-S1 in most cases.