Abstract:
Over 4 years, 450 outpatient percutaneous discectomies performed under local anesthesia by this author were analyzed. 31 patients aged 23 to 83 years underwent endoscopic percutaneous surgery with a recently developed small working channel scope providing not only nucleotome internal decompression, but also removal of extruded or separated fragments located outside the disc space. This group forms the basis of this study. All patients had suffered from sciatica for several months to many years and failed conservative care. All patients had positive MRI or CT and lumbar disc rupture findings (straight-leg raising, motor, sensory, or reflex abnormalities). The working channel endoscope consisted of a 2.8-mm plastic tube with a 6K pixel fiberoptic scope mounted in the wall. This tube was inserted inside a 4.2-mm outer diameter metal cannula. A 2.5- mm nucleotome probe plus grasping forceps and suction device fitted through this tube. Better results were obtained using the combination internal-external disc access provided by this 2.8-mm working channel endoscope. The patients were followed postoperatively for up to 4 years. "Successful" patients continued to meet all these criteria: 1) completed postoperative evaluation form, rating result "successful" or "total cure"; 2) reported increase in functional capability; 3) positive straight-leg raising abnormality resolved; 4) taking no pain medication. An overall success of 88% was achieved in the 450 patients, while the 31 endoscopic cases exhibited 90% success rate with no complications. This new endoscope increases the effectiveness of the percutaneous technique, and includes patients not previously considered candidates for percutaneous spinal surgery.

Copyright © 1995 The American Association of Neurological Surgeons. All rights reserved.