Percutaneous Endoscopic Lumbar Discectomy (PELD) is not the Conventional excision but a treatment which in between the conservative and open surgery. Therefore, it does not disrupt the normal soft tissue or the vertebral structures. After inserting a thin wire into the skin, the surgeons treat the herniated disc with laser and radio-frequency thermal effect under endoscopic guidance.
Advantages
- Under the local anesthesia, the elderly patients or even the diabetes
patients could tolerable the procedure.
- Cosmetic effects since it is minimally invasive spinal surgery.
- It preserves vertebrae and normal nucleus pulposus and removes only the lesional
site so that there is no risk of evoking the neural adhesion. Bloodless surgery,
no transfusion is required.
- It saves the time and the costs. 75% of the patients discharged on the same.
- Due to rapid recovery, comparing to open surgeries, it is recommendable for
the workers or students with the desire of early return-to-work.
Surgical Techniques
- Patient is in prone position under the local anesthesia so as to
communicate with the surgeons and nurses. The surgeon inserts the
thin wire into the disc. With the 0.6cm (diameter) of endoscope, the surgeon
could observe the inside with safety. With the better view under endoscope,
minute forceps, radio-frequency, and Holmium-YAG laser, the surgeon could
make the disc shrink so as to diminish the pain. This treatment, regarded
as the third generation, is more advancing that the previous first, second
generation laser therapy with following additional effectiveness.
- Minimized excision effect (with laser, as fine as hair, which could approach
into the small and narrow spinal canal)
- Prevent lumbar pain effect (pain nerve that distributed to posterior annulus
fibrosis)
- Disc diminishing effect (diminish the extruded disc)
- Disc intensifying effect (remodeling the collagen component of disc material)
- Hemostasis effect (coagulation)
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| Laser technique under the endoscopic view | Radio-frequency technique under the endoscopic view |
Indications
This surgical technique is in between the conservative therapy and open surgery. Therefore, either lumber disc herniation or extraforaminal stenosis is an indication, which shows no improvement after conservative therapy.
Prognosis
Successful rate is 93% and 7% showed the recurrence. The 7% recurrence was due to combined spinal canal stenosis.
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| MRI image of preoperation A ruptured disc that is dehydrated as black color between 4th and 5th lumbar vertebra is compressing the nerve root. |
MRI image 3years after the surgery The corresponding disc level I is maintaining its original height while the ruptured portion is disappeared. |
Caring for a patient after surgery
Post operative 1 week
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