Indications of Percutaneous Endoscopic Lumbar Discectomy

Lumbar Disc Herniation 

LDH has become more and more common because  of the aging population and heavy work pressure .  Symptomatic LDH should be addressed by surgical  treatment if it is intractable for conservative treatment.  Compared to open surgery, PELD has several superiorities. First, PELD has minimal trauma and blood loss. The  incision of PELD is approximately 10 mm – just enough  for the insertion of a working cannula, and blood loss  is reported to be 5 to 51 mL, which is significantly less  than that for microendoscopic discectomy (MED) and  open discectomy. Benefiting from the minimal  trauma, patients often experience a short hospital stay  and early return to work after surgery. Second,  PELD can be finished under local anesthesia or epidural  anesthesia, so that safety is more reliable for the elderly  in poor general condition. Besides, any damage to the  nerve root can be detected from the instant feedback  of patients, which enables surgeons to prevent this  catastrophic complication. Third, differing from  posterior open surgery, the working cannula used in  PELD causes minimal damage to bony elements, preserving the stabilization of the spine and reducing the  risk of secondary degenerative diseases. According to  the anatomy of lumbar spine, the scale of the foramen  decreases while the scale of the interlaminar space  increases from L1 to L5. In this situation, PETD is  suitable for LDH in L3/4 or the upper index, while PEID  is preferred in the L4/5 and L5/S1 levels.

Lumbar Stenosis 

In patients with lumbar stenosis, the volume of spinal canal or foramen is decreased and the subsequent compression of the spinal cord or nerve root results in  back pain, radiculopathy, and intermittent claudication.  The etiology of lumbar stenosis consists of lumbar disc  herniation, osteophytes of facet joints, and hypertrophy or ossification of soft tissue (posterior longitudinal  ligament and ligament flavum). Based on the site of  stenosis, lumbar stenosis is classified as central stenosis,  lateral recess stenosis, or foraminal stenosis. Foraminoplasty in PETD is able to remove osteophyte and enlarge  the scale of the foramen and lateral recess, so PETD is  suitable for foraminal stenosis and lateral recess stenosis. Soft tissues and disc fragments can be resected via  PEID with adequate operating space, so PEID is often  applied to central and lateral recess stenosis.