A retrospective study of 43 consecutive patients who underwent percutaneous endoscopic lumbar discectomy for recurrent disc herniation. To evaluate the efficacy of endoscopic discectomy for recurrent disc herniations and to determine the prognostic factors affecting surgical outcome. Repeated open discectomy with or without fusion has been the most common procedure for a recurrent lumbar disc herniation. There have been no reports published on the feasibility and prognostic factors of the endoscopic discectomy for recurrent disc herniation. The inclusion criteria were recurrent disc herniations at the same level, regardless of side, with a pain-free interval longer than 6 months after the conventional open discectomy. Posterolateral endoscopic laser-assisted disc excisions were performed under local anesthesia. The mean follow-up period was 31 months (24–39 months). Based on the MacNab criteria, 81.4% showed excellent or good outcomes. The mean visual analog scale decreased from 8.72 ± 1.20 to 2.58 ± 1.55 (P <0.0001). In our series, better outcomes were obtained in patients younger than 40 years (P = 0.035), patients with duration of symptoms of less than 3 months (P = 0.028), and patients without concurrent lateral recess stenosis (P = 0.007). Percutaneous endoscopic lumbar discectomy is effective for recurrent disc herniation in selected cases. The posterolateral approach through unscarred virgin tissue can prevent nerve injury and could preserve the spinal stability. Both foraminal and intracanalicular portions can be decompressed simultaneously.

Transforaminal percutaneous endoscopic lumbar discectomy is regarded as an effective alternative to open discectomy. Remarkable technical evolution now enables selective endoscopic removal of an epidurally extruded disc fragment. As a result, the surgical indications for this technique are becoming broader. However, as the use of endoscopic techniques increases in spinal procedures, related complications emerge as important problems. These include postoperative dysesthesia, dural tears, hematoma, infection and visceral injury. There are several technical guidelines to increase the effectiveness of endoscopic techniques and prevent complications. Initial landing should be as close to the target as possible. Complete herniotomy after thorough release of annular anchorage is a key to success. The definitive end point of the procedure is free mobilization of neural tissues, not direct exposure of neural tissues.

BACKGROUND:. Although several authors have reported the use of endoscopic techniques to treat lumbar foraminal stenosis, the practical application of th

Study Design. A prospective study. Objective. The purpose of this study was to determine the radiation dose to which the surgeons are exposed during percutaneous endoscopic lumbar discectomy (PELD) and to calculate the allowable number of cases per year. Summary of Background Data. Transforaminal PELD is a minimally invasive technique for soft disc herniation. Minimal invasiveness can be achieved through the use of fluoroscopy and endoscopy. The radiation dose to the surgeon during PELD is unknown. Methods. The occupational radiation dose absorbed by 3 spinal surgeons performing 30 consecutive PELDs (33 levels) during a 3-month period was evaluated. Transforaminal PELDs were performed according to the standard technique. The radiation exposure of the neck, chest, arm, and both hands of the surgeons was measured. Occupational exposure guidelines of National Council on Radiation Protection & Measurements were used to calculate the allowable number of procedures per year. Results. The mean operation time was 49.8 minutes, and the mean fluoroscopy time was 2.5 minutes. No significant correlations were found between operation time and fluoroscopy time. The calculated radiation doses per operated level were as follows: neck, 0.0785 mSv; chest, 0.1718 mSv; right upper arm, 0.0461 mSv; left ring finger, 0.7318 mSv; and right ring finger, 0.6694 mSv. The protective effects of a lead collar and lead apron were demonstrated by the reduction of the radiation dose by 96.9% and 94.2%, respectively. Therefore, with regard to whole-body radiation, 5379 operations can be performed per year using a lead apron, whereas only 291 operations can be performed without using a lead apron. Moreover, 1910 operations can be performed within the occupational exposure limit for the eyes (150 mSv), and 683 operations can be performed within the occupational exposure limit for the hands (500 mSv). Conclusion. Without radiation shielding, a surgeon performing 291 PELDs annually would be exposed to the maximum allowable radiation dose. Given the measurable lifetime radiation hazards to the surgeon, the use of adequate protective equipment is essential to reducing exposure during PELD.

Introduction: Endoscopic spine surgery has been developed as a minimally invasive technique for decompression in patients with lumbar disc herniation or lumbar stenosis. Recent reports have described the use of endoscopic technology in lumbar fusion surgeries, especially for transforaminal lumbar interbody fusion (TLIF). This review aimed to summarize the current techniques of endoscopic TLIF and to discuss the benefits, limitations, and future perspectives of endoscopic lumbar fusion surgery. Areas covered: This review covered the English-language medical literature published in Medline and focused specifically on endoscopic technologies incorporated into minimally invasive TLIF. The endoscopic TLIF techniques are categorized here according to the properties of the endoscope: percutaneous endoscopic TLIF, biportal endoscopic TLIF, and microendoscopic TLIF. Even though most authors have reported favorable clinical and radiological outcomes of endoscopic TLIF, such evidence originates mainly from case series. Expert opinion: Although the current level of evidence is low and the technical relevance of the technique is controversial, the key concept and early results of endoscopic TLIF are promising. Technical advancements to improve safety and reduce technical complexity, as well as comparative cohort studies and randomized clinical trials with long-term follow-up are required to promote the adoption of endoscopic TLIF in clinical practice.